Basic Information
| Provider Information | |||||||||
| NPI: | 1851404552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOLAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 VINEYARD DR | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600315156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477216749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1508 VINEYARD DR | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600315156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473679924 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.