Provider Demographics
NPI:1528517653
Name:GREIF, DAKOTAH CATHERINE (DPT)
Entity type:Individual
Prefix:
First Name:DAKOTAH
Middle Name:CATHERINE
Last Name:GREIF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DAKOTAH
Other - Middle Name:CATHERINE
Other - Last Name:BOSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:52 RISING SUN TOWN CTR
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911
Practice Address - Country:US
Practice Address - Phone:410-658-0100
Practice Address - Fax:410-658-0199
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist