Healthcare Provider Details

I. General information

NPI: 1215133780
Provider Name (Legal Business Name): PLATTNER PEDORTHIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SHOOTING PARK RD SUITE 101 B
PERU IL
61354-1870
US

IV. Provider business mailing address

1001 SHOOTING PARK RD SUITE 101 B
PERU IL
61354-1870
US

V. Phone/Fax

Practice location:
  • Phone: 815-220-1382
  • Fax: 815-220-1300
Mailing address:
  • Phone: 815-220-1382
  • Fax: 815-220-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG A PLATTNER
Title or Position: PRESIDENT
Credential: CO
Phone: 309-682-1382