Provider Demographics
NPI:1295349959
Name:FRYMIRE, DENNIS (LMT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:FRYMIRE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 N MONTICELLO AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5617
Mailing Address - Country:US
Mailing Address - Phone:773-332-6705
Mailing Address - Fax:
Practice Address - Street 1:4955 N MONTICELLO AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5617
Practice Address - Country:US
Practice Address - Phone:773-332-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist