Provider Demographics
NPI:1952741571
Name:STEDNITZ, BRYAN M (PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:STEDNITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:0S050 WINFIELD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1227
Practice Address - Country:US
Practice Address - Phone:630-653-4743
Practice Address - Fax:630-653-4912
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400101137Medicare PIN
ILF400110857Medicare PIN