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General NPI Number Information
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NPI Number | 1740843267
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Entity Type | Organization
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Legal Business Name | PANOPTIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 1511 N. CONVENT ST SUITE 1000
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 815-401-5102
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Fax | 815-401-5103
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Provider Business Mailing Address
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Address Line | 1802 N DIVISION ST SUITE 202
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City | MORRIS
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State | IL
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Zip | 60450
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Country | US
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Telephone | 815-513-3298
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | GERALD EDWARD MERTES III
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Credential |
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Telephone | 815-513-3298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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