Individual
MR. GRANT PANZELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
11917 LERWICK RD, CALEDONIA, IL 61011-9781
(815) 914-6650
Mailing address
11917 LERWICK RD, CALEDONIA, IL 61011-9781
(815) 914-6650
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.026061
IL
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/15/2015
Last updated
11/01/2021
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