Provider Demographics
NPI:1265465116
Name:DALLAS, JAMES A (LPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DALLAS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST
Mailing Address - Street 2:STE. #305
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4977
Mailing Address - Country:US
Mailing Address - Phone:630-792-9790
Mailing Address - Fax:630-792-9794
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:STE. #305
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4977
Practice Address - Country:US
Practice Address - Phone:630-792-9790
Practice Address - Fax:630-792-9794
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL650018881OtherRAIL ROAD MEDICARE
ILL75039Medicare ID - Type Unspecified
ILIL1443001Medicare PIN
IL650018881OtherRAIL ROAD MEDICARE