Charles Grandt, PT, DPT
Individual provider Active NPI Physical Therapist · Bannockburn, IL
NPI 1740911429 · NPPES record last updated Jun 22, 2022
Key facts
- NPI
- 1740911429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070025959 (IL)
- Practice address
- 2151 Waukegan Rd
Ste 130
Bannockburn, IL 60015-1868 - Phone
- (847) 444-1321
- NPI assigned
- Jun 22, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070025959 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070025959 | IL | Yes |
Addresses
Primary practice location
2151 Waukegan Rd
Ste 130
Bannockburn, IL 60015-1868
Mailing address
6744 Roanoake CT
Gurnee, IL 60031-4011
Phone (847) 650-1927
Other providers in Bannockburn, IL
- Michelle Galligan
- Sharon Gawin
- Geriatric Care NP Associates
- Jonathan M Gilbert
- Cathlynn Goldufsky
- Lianna Rose Greene
- Brad K. Greenspan
- Rachel Gross
- Growing From Within
- James Edward Gruenewald
All providers in Bannockburn, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.