Provider Demographics
NPI:1457707085
Name:GNANDT, CHRIS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:GNANDT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60940-5566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:GRANT PARK
Practice Address - State:IL
Practice Address - Zip Code:60940-5566
Practice Address - Country:US
Practice Address - Phone:216-630-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist