Provider Demographics
NPI:1316977036
Name:TRESS, DANA S (PT, STS, CEAS)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:S
Last Name:TRESS
Suffix:
Gender:F
Credentials:PT, STS, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TALISMON DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1728 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5414
Practice Address - Country:US
Practice Address - Phone:815-578-8905
Practice Address - Fax:815-578-8904
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05623778OtherBLUECROSS/BLUE SHIELD
IL070010460OtherSTATE LICENSE NUMBER
ILK24907Medicare PIN
IL070010460OtherSTATE LICENSE NUMBER