Healthcare Provider Details

I. General information

NPI: 1356823827
Provider Name (Legal Business Name): ROSS ENYART DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

1 KETTERING LN
LEMONT IL
60439-3905
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2633
  • Fax:
Mailing address:
  • Phone: 630-699-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023856
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: