Healthcare Provider Details

I. General information

NPI: 1508088030
Provider Name (Legal Business Name): NORTH SHORE SPINAL & SPORTS REHABILITATION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 1ST ST STE 100
HIGHLAND PARK IL
60035-3210
US

IV. Provider business mailing address

1770 1ST ST STE 100
HIGHLAND PARK IL
60035-3210
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-4077
  • Fax: 847-681-8940
Mailing address:
  • Phone: 847-432-4077
  • Fax: 847-681-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW JOHNSON
Title or Position: DIRECTOR
Credential: PT, DPT
Phone: 847-432-4077