Provider Demographics
NPI:1770203705
Name:DUFORD, DENALI BROOKE TARA (DPT)
Entity type:Individual
Prefix:
First Name:DENALI
Middle Name:BROOKE TARA
Last Name:DUFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:200 OKATIE VILLAGE DR STE 105
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7526
Practice Address - Country:US
Practice Address - Phone:843-706-2861
Practice Address - Fax:843-706-2864
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCP034861T225100000X
OHCP018677T225100000X
WAPT61268007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist