Provider Demographics
NPI:1972927994
Name:DADIZ, CYNTHIA (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DADIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2283
Mailing Address - Country:US
Mailing Address - Phone:708-214-2708
Mailing Address - Fax:
Practice Address - Street 1:6821 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2283
Practice Address - Country:US
Practice Address - Phone:708-214-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist