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General NPI Number Information
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NPI Number | 1053543041
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Entity Type | Individual
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Provider Name | WYNN E. KANTEN P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 421 DORIS AVE
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City | JOLIET
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State | IL
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Zip | 60433-2569
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Country | US
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Telephone | 815-727-8776
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Fax | 815-727-8775
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Provider Business Mailing Address
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Address Line | 22703 LAWNDALE AVE
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City | RICHTON PARK
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State | IL
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Zip | 60471-2540
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Country | US
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Telephone | 708-503-1951
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Fax | 708-248-7771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.005101
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License Number State | IL
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