=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407104680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENA DENNY PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2012
-----------------------------------------------------
Last Update Date | 08/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5057 SHORELINE RD
-----------------------------------------------------
City | LAKE BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-529-2093
-----------------------------------------------------
Fax | 847-620-0755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 874 SINGING HILLS DR
-----------------------------------------------------
City | VOLO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60073-8206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-529-2093
-----------------------------------------------------
Fax | 847-620-0755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DENA DENNY
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 815-529-2093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 070012760
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------