Provider Demographics
NPI:1487764718
Name:VANNI, CONSTANCE H (PT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:H
Last Name:VANNI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3519
Mailing Address - Country:US
Mailing Address - Phone:815-334-0400
Mailing Address - Fax:815-334-0800
Practice Address - Street 1:113 S EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3519
Practice Address - Country:US
Practice Address - Phone:815-334-0400
Practice Address - Fax:815-334-0800
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568150OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
ILDC7571OtherR R MEDICARE GRP #
ILP00199532OtherR R MEDICARE PIN #
IL568080OtherMEDICARE GROUP NUMBER
IL1623066OtherBCBS PROVIDER #
IL367885100OtherUS DEPT OF LABOR PROV #
IL1619908OtherBCBS IL GROUP NUMBER
ILL92998Medicare PIN
ILK51718Medicare PIN
IL1619908OtherBCBS IL GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
ILK51717Medicare PIN
IL1623066OtherBCBS PROVIDER #