Healthcare Provider Details

I. General information

NPI: 1326344730
Provider Name (Legal Business Name): DAVID MARTIN GARCIA KT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY ROAD
NORTH CHICAGO IL
60064
US

IV. Provider business mailing address

428 E. SCHILLER AVE.
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-1900
  • Fax:
Mailing address:
  • Phone: 630-853-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: