Provider Demographics
NPI:1033446521
Name:RESER, MICHAEL DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:RESER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29855 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60145-8541
Mailing Address - Country:US
Mailing Address - Phone:815-748-8900
Mailing Address - Fax:815-758-0717
Practice Address - Street 1:2111 MIDLANDS CT
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3125
Practice Address - Country:US
Practice Address - Phone:815-748-8900
Practice Address - Fax:815-758-0717
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070.004516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist