Provider Demographics
NPI:1639384613
Name:GARCIA, DENNIS T (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:T
Last Name:GARCIA
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 1:24302 CHAMPION DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-1590
Mailing Address - Country:US
Mailing Address - Phone:815-931-3641
Mailing Address - Fax:815-609-7792
Practice Address - Street 1:24302 CHAMPION DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-1590
Practice Address - Country:US
Practice Address - Phone:815-931-3641
Practice Address - Fax:815-609-7792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist