Provider Demographics
NPI:1750966289
Name:JANNUSCH, CARL STEPHEN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:STEPHEN
Last Name:JANNUSCH
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 1:1200 N WESTMORELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1601
Mailing Address - Country:US
Mailing Address - Phone:847-535-7550
Mailing Address - Fax:847-535-7840
Practice Address - Street 1:1200 N WESTMORELAND RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1601
Practice Address - Country:US
Practice Address - Phone:847-535-7550
Practice Address - Fax:847-535-7840
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist