Provider Demographics
NPI:1639210487
Name:CARTER, DENNIS (MPT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 ARTESIAN RD STE 152
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4876
Mailing Address - Country:US
Mailing Address - Phone:630-857-3856
Mailing Address - Fax:
Practice Address - Street 1:2960 ARTESIAN RD STE 152
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4876
Practice Address - Country:US
Practice Address - Phone:630-857-3856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931559OtherMEDICARE RAILROAD
ILP00439238Medicare PIN
IL202845098Medicare PIN
ILK40537Medicare PIN