Individual provider Active NPI

Dennis Fung, PT

  • Physical Therapist
  • Bourbonnais, IL
National Provider Identifier
1740512870
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.016852 Issued in IL
Practice address
215 N Convent St
Suite 6
Bourbonnais, IL 60914-5600
Phone
(815) 928-8357
Fax
(815) 929-0492
NPI assigned
Jan 29, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.016852 IL Primary

Addresses

Primary practice location

215 N Convent St
Suite 6
Bourbonnais, IL 60914-5600

Mailing address

201 27TH Ave
Brooklyn, NY 11214-6703
Phone (212) 729-1112

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

LicenseStateTypeSpecialty
070.016852ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Axcess Physical Therapy, LLC Physical Therapist PastSince Oct 1, 2009 Accepting new patients
Accelerated Rehabilitation Centers LTD Physical Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1740512870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 27TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112146703",
            "telephone_number": "212-729-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N CONVENT ST",
            "address_2": "SUITE 6",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145600",
            "telephone_number": "815-928-8357",
            "fax_number": "815-929-0492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNG",
        "first_name": "DENNIS",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-29",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.016852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.