| |
109 W Front St, Harvard, IL 60033-2833 | |
(312) 804-9332 | |
(815) 943-0196 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 109 W Front St, Harvard, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720104110 | NPI | - | NPPES |
1634788 | Other | IL | BLUE CROSS BLUE SHEILD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2251X0800X | Physical Therapist - Orthopedic | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Geoffrey Joseph Gentry |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1831275379 PECOS PAC ID: 5698660132 Enrollment ID: I20040216000440 |
Provider Name | Earl E Gunther |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1144230582 PECOS PAC ID: 3173573326 Enrollment ID: I20050127000178 |
Mailing Address | Practice Location Address |
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12172 S State Route 47 Ste 319, Huntley, IL 60142-9619 Ph: (312) 804-9332 | 109 W Front St, Harvard, IL 60033-2833 Ph: (312) 804-9332 |