Provider Demographics
NPI:1437139821
Name:LACALLE, DENNIS MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:LACALLE
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 1:5605 MILTON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-5124
Mailing Address - Country:US
Mailing Address - Phone:530-409-4941
Mailing Address - Fax:916-200-0430
Practice Address - Street 1:5605 MILTON RANCH RD
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-5124
Practice Address - Country:US
Practice Address - Phone:530-409-4941
Practice Address - Fax:916-200-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27117Medicare UPIN
CA00PT85493Medicare ID - Type Unspecified