Healthcare Provider Details

I. General information

NPI: 1558854216
Provider Name (Legal Business Name): MANTE GEDVILIENE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANTE BALIUTAVICIUTE PT, DPT

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD STE 315
ELMHURST IL
60126-5068
US

IV. Provider business mailing address

24014 W RENWICK RD UNIT 206
PLAINFIELD IL
60544-8711
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-4378
  • Fax: 630-515-1536
Mailing address:
  • Phone: 800-974-4378
  • Fax: 630-515-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: