Provider Demographics
NPI:1801989819
Name:SMITH, DENISE F (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W WOODSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4239
Mailing Address - Country:US
Mailing Address - Phone:815-893-9075
Mailing Address - Fax:844-862-9452
Practice Address - Street 1:110 W WOODSTOCK ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4239
Practice Address - Country:US
Practice Address - Phone:815-893-9075
Practice Address - Fax:844-862-9452
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK34003Medicare PIN
ILP00409736Medicare PIN