Healthcare Provider Details

I. General information

NPI: 1780562496
Provider Name (Legal Business Name): GARNET BLANDO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 N MILWAUKEE AVE STE 2
CHICAGO IL
60647-6905
US

IV. Provider business mailing address

1658 N MILWAUKEE AVE STE 2
CHICAGO IL
60647-6905
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-2812
  • Fax: 773-355-2844
Mailing address:
  • Phone: 773-355-2812
  • Fax: 773-355-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.026847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: