Provider Demographics
NPI:1588419295
Name:VANT, THOMAS MICHAEL (DPT, ATC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:VANT
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 N PECATONICA RD
Mailing Address - Street 2:
Mailing Address - City:LEAF RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:61047-9402
Mailing Address - Country:US
Mailing Address - Phone:630-809-9838
Mailing Address - Fax:
Practice Address - Street 1:7212 N PECATONICA RD
Practice Address - Street 2:
Practice Address - City:LEAF RIVER
Practice Address - State:IL
Practice Address - Zip Code:61047-9402
Practice Address - Country:US
Practice Address - Phone:630-809-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960038782081S0010X
AZLPT-013303225100000X
IL070020903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine