Basic Information
| Provider Information | |||||||||
| NPI: | 1003914235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRILL | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SMYRNA CLAYTON BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SMYRNA | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199772228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026593102 | ||||||||
| FaxNumber: | 3026535423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1 0002102 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.