Provider Demographics
NPI:1730610544
Name:DAL DEGAN, TARYN SUSAN (DPT, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:TARYN
Middle Name:SUSAN
Last Name:DAL DEGAN
Suffix:
Gender:F
Credentials:DPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MAPLE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3134
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:224-271-5556
Practice Address - Street 1:1704 MAPLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3134
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:224-271-5556
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12585225100000X
IL2255A2300X
IL070027302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer