Provider Demographics
NPI:1326092685
Name:KLEINMEYER, DAVID GERARD (DPT ATC L)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GERARD
Last Name:KLEINMEYER
Suffix:
Gender:M
Credentials:DPT ATC L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:800 DES PLAINES AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2035
Practice Address - Country:US
Practice Address - Phone:708-366-2442
Practice Address - Fax:708-366-0179
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6697017OtherMEDICARE
ILIL6237006OtherMEDICARE
ILIL6238006OtherMEDICARE
ILIL6237006OtherMEDICARE
ILK26931Medicare PIN
IL$$$$$$$$$001Medicaid