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NPI Code Detail

MEDICARE: DENNIS G CANDELARIA

MEDICARE: DENNIS G CANDELARIA
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
1225100000XPhysical Therapist070014713IL

General Provider Information

NPI Number : 1558692822
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS G CANDELARIA
Provider Business Mailing Address
First Line : 23528 N EAST RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-8815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4101 LAKE COOK RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1112
Country : US
Telephone Number : 847-562-1770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2010
Last Update Date : 01/26/2010

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Directions to “ DENNIS G CANDELARIA ” Practice Location

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