Healthcare Provider Details

I. General information

NPI: 1598580813
Provider Name (Legal Business Name): BRIAN GEBERT JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N CLARK ST
CHICAGO IL
60614-1551
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 773-969-4790
  • Fax: 773-969-4790
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070028772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: