Provider Demographics
NPI:1407869738
Name:DUPAGE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DUPAGE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:DEMETRA
Authorized Official - Last Name:PANAGIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:630-653-9995
Mailing Address - Street 1:310 S COUNTY FARM RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-653-9995
Mailing Address - Fax:630-653-9959
Practice Address - Street 1:310 S COUNTY FARM RD
Practice Address - Street 2:UNIT D
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-653-9995
Practice Address - Fax:630-653-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7576630OtherAETNA
IL2220622OtherBCBS
ILC16248OtherRAILROAD MEDICARE
IL7576630OtherAETNA