Provider Demographics
NPI:1497760060
Name:PANAGIOTIS, ANITA DEMETRA (MS PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:DEMETRA
Last Name:PANAGIOTIS
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7576630OtherAETNA
ILC16248OtherRAILROAD MEDICARE
IL070003081OtherBCBS
ILL53056Medicare ID - Type Unspecified