Provider Demographics
NPI:1558316687
Name:MANI, KAARTHICK K (PT, DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:KAARTHICK
Middle Name:K
Last Name:MANI
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 WEHRLI RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-9317
Mailing Address - Country:US
Mailing Address - Phone:630-637-1693
Mailing Address - Fax:630-470-9256
Practice Address - Street 1:1827 WEHRLI RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-9317
Practice Address - Country:US
Practice Address - Phone:630-637-1693
Practice Address - Fax:630-470-9256
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5537001Medicare PIN
ILF400101699Medicare PIN