Provider Demographics
NPI:1730686957
Name:DINLASAN, VIJIEY HERVERA
Entity type:Individual
Prefix:MR
First Name:VIJIEY
Middle Name:HERVERA
Last Name:DINLASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 N WASHTENAW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2654
Mailing Address - Country:US
Mailing Address - Phone:872-207-8519
Mailing Address - Fax:
Practice Address - Street 1:6204 N WASHTENAW AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2654
Practice Address - Country:US
Practice Address - Phone:872-207-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist