Provider Demographics
NPI:1598886327
Name:BRYANT, EDITH (DPT)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:1527 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1307
Practice Address - Country:US
Practice Address - Phone:312-642-8114
Practice Address - Fax:312-642-8504
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
ILR00698Medicare PIN
IL568150OtherMEDICARE GROUP NUMBER