MEDICARE: MR. DENNIS NINK P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070-004027	IL

General Provider Information

NPI Number	:	1528231933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS NINK P.T.

Provider Business Mailing Address
First Line	:	4231 PROGRESS BLVD
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354
Country	:	US
Telephone Number	:	815-220-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 PROGRESS BLVD
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-1193
Country	:	US
Telephone Number	:	815-220-8808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	05/08/2015

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