Healthcare Provider Details

I. General information

NPI: 1578492609
Provider Name (Legal Business Name): NICHOLAS MILOSCH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 GRAND AVE
RIVER GROVE IL
60171-3603
US

IV. Provider business mailing address

8937 GRAND AVE
RIVER GROVE IL
60171-3603
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-1354
  • Fax:
Mailing address:
  • Phone: 708-453-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: