Vitaliy M Stefanov, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-025188 Issued in IL

Practice address

2211 Waukegan Rd
Bannockburn, IL 60015-1570

Phone

(847) 267-8600

Fax

(847) 267-9520

NPI assigned

Sep 10, 2020

Last updated

Sep 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1922613579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OAKMONT LN STE 600C",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595548",
            "telephone_number": "630-575-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 WAUKEGAN RD",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151570",
            "telephone_number": "847-267-8600",
            "fax_number": "847-267-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEFANOV",
        "first_name": "VITALIY",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-025188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Patrick Shortal, MD
• Lori Siegel, MD
• Jacqueline Mary Sieros, MD, MPH
• Annie Maria Skariah, MD
• Spot 26 Therapy
• Still Water Physical Therapy and Massage, LTD
• Sharon Judith Strauss, PHD
• Zechariah Kaine Strine, LSW
• Jane Lucile Sussman, MSW., LSW.
• Sean Sutphen, DO

• Physical Therapist in Bannockburn, IL
• Providers in Bannockburn, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.