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General NPI Number Information
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NPI Number | 1356997803
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Entity Type | Individual
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Provider Name | CONNOR PATRICK GANZER PT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 15960 ASHFORD CT
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City | TINLEY PARK
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State | IL
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Zip | 60477-6750
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Country | US
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Telephone | 304-371-4876
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Fax | 855-462-3009
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Provider Business Mailing Address
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Address Line | 15960 ASHFORD CT
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City | TINLEY PARK
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State | IL
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Zip | 60477-6750
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Country | US
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Telephone | 630-437-1487
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Fax | 855-462-3009
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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 | 070024348
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License Number State | IL
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