Provider Demographics
NPI:1174649628
Name:PICA, GERALD DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DEAN
Last Name:PICA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-3400
Mailing Address - Fax:217-326-2324
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-337-2377
Practice Address - Fax:217-326-2324
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002194225100000X
IL070.002194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
IL203OtherBLUE CROSS PROV ID
IL4117OtherHAMP PROV ID
7216OtherPERSONALCARE PROV ID
7216OtherPERSONALCARE PROV ID