Healthcare Provider Details

I. General information

NPI: 1114486099
Provider Name (Legal Business Name): BRETT PAINTER DPT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W ARMITAGE AVE
CHICAGO IL
60614-4103
US

IV. Provider business mailing address

435 W ERIE ST APT 1605
CHICAGO IL
60654-6985
US

V. Phone/Fax

Practice location:
  • Phone: 815-978-3298
  • Fax:
Mailing address:
  • Phone: 815-978-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRETT PAINTER
Title or Position: PRESIDENT
Credential: PT, DPT, COMT
Phone: 815-978-3298