Active NPI
Dennis G Candelaria
- Physical Therapist
- Northbrook, IL
National Provider Identifier
1558692822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070014713
- Practice address
- 4101 Lake Cook Rd
Northbrook, IL 60062-1112 - Phone
- (847) 562-1770
- NPI assigned
- Jan 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070014713 | IL | Primary |
Addresses
Primary practice location
4101 Lake Cook Rd
Northbrook, IL 60062-1112
Mailing address
23528 N East Rd
Lake Zurich, IL 60047-8815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070014713 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1558692822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23528 N EAST RD",
"city": "LAKE ZURICH",
"state": "IL",
"postal_code": "600478815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 LAKE COOK RD",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621112",
"telephone_number": "847-562-1770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANDELARIA",
"first_name": "DENNIS",
"middle_name": "G",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-26",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070014713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.