Panoptic Physical Therapy LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PANOPTIC PHYSICAL THERAPY LLC

Practice address

1521 N Convent St
Suite 1000
Bourbonnais, IL 60914

Phone

(815) 210-9010

Fax

(815) 513-5446

NPI assigned

May 16, 2019

Organization subpart

Yes

Parent organization

PANOPTIC PHYSICAL THERAPY LLAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gerald Edward Mertes III, LNHA

Title

Chief Operating Officer

Phone

(815) 513-3298

Specialties & licenses 1

Addresses

Other names 1

• Panoptic Physical Therapy - Bourbonnais Doing business as

Tax ID family

Panoptic Physical Therapy LLC2 organizations share this tax ID, including this one

Part of

Panoptic Physical Therapy LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Panoptic Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Bourbonnais, IL
  • NPI 1740843267
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1639735418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 DIVISION ST",
            "address_2": "SUITE 202",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "60450",
            "telephone_number": "815-513-3298",
            "fax_number": "815-513-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 N CONVENT ST",
            "address_2": "SUITE 1000",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-210-9010",
            "fax_number": "815-513-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANOPTIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PANOPTIC PHYSICAL THERAPY LL",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A",
        "authorized_official_last_name": "MERTES",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "815-513-3298",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panoptic Physical Therapy - Bourbonnais",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samuel Osobu, D.M.D
• Tammie Jo Ostrowski, PT
• Sheryl Ann Palinski, LCPC
• Pamela Ford Counseling Limited
• Panoptic Physical Therapy LLC
• Panoptic Physical Therapy LLC
• Michael Albert Panozzo, RFA
• J Michael Panuska, MD, MPH
• Azra N Pappa, DO
• Dhaval Patel, D.O.

• Physical Medicine & Rehabilitation Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.