MEDICARE: CHARLOTTE VICENTE-BRANDON 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	070010906	IL

General Provider Information

NPI Number	:	1710196605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE VICENTE-BRANDON PT

Provider Business Mailing Address
First Line	:	455 BRIARGATE DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	847-622-0506
Fax Number	:	847-622-0507

Provider Business Practice Location Address
First Line	:	455 BRIARGATE DR STE 100
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	847-622-0506
Fax Number	:	847-622-0507

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	11/07/2023

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Directions to “ CHARLOTTE VICENTE-BRANDON PT” Practice Location

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