MEDICARE: DEAN R COULTER DPT

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	070026687	IL

General Provider Information

NPI Number	:	1326777137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN R COULTER DPT

Provider Business Mailing Address
First Line	:	2540 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2314
Country	:	US
Telephone Number	:	877-632-6637
Fax Number	:	708-409-5179

Provider Business Practice Location Address
First Line	:	2540 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2314
Country	:	US
Telephone Number	:	877-632-6637
Fax Number	:	708-409-5179

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	10/25/2022

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Directions to “ DEAN R COULTER DPT” Practice Location

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