Healthcare Provider Details

I. General information

NPI: 1861318818
Provider Name (Legal Business Name): MATEYA RETTIG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N ELSTON AVE
CHICAGO IL
60642-1544
US

IV. Provider business mailing address

1739 N ELSTON AVE
CHICAGO IL
60642-1544
US

V. Phone/Fax

Practice location:
  • Phone: 773-687-9241
  • Fax: 773-305-5543
Mailing address:
  • Phone: 773-687-9241
  • Fax: 773-305-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070.039857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: