Provider Demographics
NPI:1013167915
Name:DOVICO, KATHERINE ANN (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:DOVICO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:4929 W RAY RD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6228
Practice Address - Country:US
Practice Address - Phone:480-729-8292
Practice Address - Fax:480-651-8119
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ82302251X0800X, 225100000X
AZLPT-31109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z125204Medicare PIN