MEDICARE: MR. DENNIS MICHAEL LACALLE PT

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	8549	CA

General Provider Information

NPI Number	:	1437139821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS MICHAEL LACALLE PT

Provider Business Mailing Address
First Line	:	5605 MILTON RANCH RD
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-5124
Country	:	US
Telephone Number	:	530-409-4941
Fax Number	:	916-200-0430

Provider Business Practice Location Address
First Line	:	5605 MILTON RANCH RD
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-5124
Country	:	US
Telephone Number	:	530-409-4941
Fax Number	:	916-200-0430

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/22/2008

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