Doctor Name: | MS. KRYSTAL MARIE GANTNER |
NPI Number: | 1962730234 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MPT |
License Number: | 070017512 |
Business Practice Address: | 4111 N Illinois St Suite C Swansea, IL - 622267609 |
Business Phone Number: | 6182350700 |
Business Fax Number: | |
Mailing Address: | 4111 N Illinois St, Suite C SWANSEA |
State: | IL |
Postal Code: | 622267609 |
Phone Number: | 6182350700 |
Fax Number: | |
NPI Enumeration Date: | 11/25/2009 |
NPI Last Update Date: | 01/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 070017512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |