Provider Demographics
NPI:1104840289
Name:PIANTEK, BRYAN (PT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:PIANTEK
Suffix:
Gender:M
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:12004 S ROUTE 59 UNIT 100
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5108
Practice Address - Country:US
Practice Address - Phone:630-967-2000
Practice Address - Fax:815-676-2594
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008830A225100000X
IL070015015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622333OtherBLUE CROSS BLUE SHIELD
ILP01055667OtherMEDICARE RAILROAD
IL7454077OtherAETNA
ILP01055667OtherMEDICARE RAILROAD