Provider Demographics
NPI:1477512523
Name:DEAN, JOHN TREVOR (PT,DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TREVOR
Last Name:DEAN
Suffix:
Gender:M
Credentials:PT,DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24014 W RENWICK RD
Mailing Address - Street 2:STE F
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:125 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-5137
Practice Address - Country:US
Practice Address - Phone:517-223-8308
Practice Address - Fax:517-223-8344
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP22890002Medicare PIN