Healthcare Provider Details

I. General information

NPI: 1578477113
Provider Name (Legal Business Name): MICHAEL ANTHONY HAHNDORF DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 GATEWAY CENTER DR
BELVIDERE IL
61008-9303
US

IV. Provider business mailing address

650 CASSIA CT
CRYSTAL LAKE IL
60012-2313
US

V. Phone/Fax

Practice location:
  • Phone: 815-547-9580
  • Fax: 815-547-9930
Mailing address:
  • Phone: 815-321-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.027938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: