Healthcare Provider Details

I. General information

NPI: 1346603669
Provider Name (Legal Business Name): STEPHANIE LANDIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W BELMONT AVE STE 350
CHICAGO IL
60657-5785
US

IV. Provider business mailing address

1333 W BELMONT AVE STE 350
CHICAGO IL
60657-5785
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 312-926-1377
Mailing address:
  • Phone: 630-933-1500
  • Fax: 312-926-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020883
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1331024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: