Provider Demographics
NPI:1215311535
Name:EPSHTEYN, DMITRIY (PTA)
Entity type:Individual
Prefix:MR
First Name:DMITRIY
Middle Name:
Last Name:EPSHTEYN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:DMITRIY
Other - Middle Name:
Other - Last Name:EPSHTEYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:7001 W CULLOM AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-7100
Mailing Address - Country:US
Mailing Address - Phone:708-457-0700
Mailing Address - Fax:
Practice Address - Street 1:7001 CULLOM AVE.
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706
Practice Address - Country:US
Practice Address - Phone:708-457-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant