Provider Demographics
NPI:1770531311
Name:GHENA, DAVID RICHARD (DHSC PT SCS ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:GHENA
Suffix:
Gender:M
Credentials:DHSC PT SCS ATC
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:
Mailing Address - Fax:
Practice Address - Street 1:3177 S 3RD PL
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3785
Practice Address - Country:US
Practice Address - Phone:812-514-3096
Practice Address - Fax:812-301-6667
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005458225100000X
WAPT00007154225100000X
AZ225100000X
IN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8342073Medicaid
S57495Medicare UPIN
WAAB13919Medicare ID - Type Unspecified
WAAB13920Medicare ID - Type Unspecified