MEDICARE: CONSTANCE H VANNI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070004961	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	568150	OTHER	IL	MEDICARE GROUP NUMBER
2	567700	OTHER	IL	MEDICARE GROUP NUMBER
3	DC7571	OTHER	IL	R R MEDICARE GRP #
4	P00199532	OTHER	IL	R R MEDICARE PIN #
5	568080	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	1623066	OTHER	IL	BCBS PROVIDER #
7	367885100	OTHER	IL	US DEPT OF LABOR PROV #
8	1619908	OTHER	IL	BCBS IL GROUP NUMBER

General Provider Information

NPI Number	:	1487764718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE H VANNI PT

Provider Business Mailing Address
First Line	:	113 S EASTWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3519
Country	:	US
Telephone Number	:	815-334-0400
Fax Number	:	815-334-0800

Provider Business Practice Location Address
First Line	:	113 S EASTWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3519
Country	:	US
Telephone Number	:	815-334-0400
Fax Number	:	815-334-0800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/12/2016

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Directions to “ CONSTANCE H VANNI PT” Practice Location

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