Provider Demographics
NPI:1881704088
Name:PIGNATARO, CARLA A (PT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:PIGNATARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:2900 FOXFIELD RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-587-5788
Practice Address - Fax:630-587-8570
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER #
IL1619908OtherBCBS IL GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR PROV #
IL1619908OtherBCBS IL GROUP NUMBER
IL568150Medicare PIN
IL567700Medicare PIN
IL367885100OtherUS DEPT OF LABOR PROV #
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILK53308Medicare PIN
ILK14713Medicare PIN
ILK53309Medicare PIN