Healthcare Provider Details

I. General information

NPI: 1992616239
Provider Name (Legal Business Name): AUSTIN DANIEL NOBBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 S ELMHURST RD STE 110
MOUNT PROSPECT IL
60056-5517
US

IV. Provider business mailing address

3407 ROYAL WOODS DR
CRYSTAL LAKE IL
60014-4799
US

V. Phone/Fax

Practice location:
  • Phone: 847-786-2014
  • Fax:
Mailing address:
  • Phone: 815-355-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.020768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: