Provider Demographics
NPI:1003914235
Name:BRILL, CRAIG ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANDREW
Last Name:BRILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1000 SMYRNA CLAYTON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-2228
Practice Address - Country:US
Practice Address - Phone:302-659-3102
Practice Address - Fax:302-653-5423
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1 0002102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare PIN
DE349181ZBSXMedicare PIN