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NPI Code Detail

MEDICARE: BRYAN PIANTEK PT

MEDICARE: BRYAN PIANTEK 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
1225100000XPhysical Therapist05008830AIN
2225100000XPhysical Therapist070015015IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01055667OTHERILMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101622333OTHERILBLUE CROSS BLUE SHIELD
37454077OTHERILAETNA

General Provider Information

NPI Number : 1104840289
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN PIANTEK PT
Provider Business Mailing Address
First Line : PO BOX 713260
Second Line :
City : CHICAGO
State : IL
Zip : 60677-1260
Country : US
Telephone Number : 630-469-9200
Fax Number :
Provider Business Practice Location Address
First Line : 12004 S ROUTE 59 UNIT 100
Second Line :
City : PLAINFIELD
State : IL
Zip : 60585-5108
Country : US
Telephone Number : 630-967-2000
Fax Number : 815-676-2594
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 08/22/2025

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