Provider Demographics
NPI:1356997803
Name:GANZER, CONNOR PATRICK (PT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:PATRICK
Last Name:GANZER
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 1:15960 ASHFORD CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6750
Mailing Address - Country:US
Mailing Address - Phone:630-437-1487
Mailing Address - Fax:855-462-3009
Practice Address - Street 1:15960 ASHFORD CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6750
Practice Address - Country:US
Practice Address - Phone:304-371-4876
Practice Address - Fax:855-462-3009
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist