Provider Demographics
NPI:1730992983
Name:DEFFEBAUGH, DYLAN G (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:G
Last Name:DEFFEBAUGH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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:410-648-4878
Practice Address - Street 1:5250 HIGHWAY 78 STE 200
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4253
Practice Address - Country:US
Practice Address - Phone:972-244-4270
Practice Address - Fax:972-476-9903
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1404369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist