Healthcare Provider Details

I. General information

NPI: 1982435921
Provider Name (Legal Business Name): NICHOLAS CONRAD LEW PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 JORIE BLVD STE 58
OAK BROOK IL
60523-3878
US

IV. Provider business mailing address

900 JORIE BLVD STE 58
OAK BROOK IL
60523-3878
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-6919
  • Fax: 630-895-4235
Mailing address:
  • Phone: 630-832-6919
  • Fax: 630-895-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070028363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: