Healthcare Provider Details

I. General information

NPI: 1275291932
Provider Name (Legal Business Name): JACOB SOWATZKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W580 BUTTERFIELD RD
OAKBROOK TERRACE IL
60181-4028
US

IV. Provider business mailing address

130 N WILMETTE AVE
WESTMONT IL
60559-1731
US

V. Phone/Fax

Practice location:
  • Phone: 630-889-8125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.028249
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: