Healthcare Provider Details

I. General information

NPI: 1508643206
Provider Name (Legal Business Name): MICHELLE CHERNYAVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E DUNDEE RD
WHEELING IL
60090-3006
US

IV. Provider business mailing address

89 MANCHESTER DR
BUFFALO GROVE IL
60089-6768
US

V. Phone/Fax

Practice location:
  • Phone: 847-877-2405
  • Fax:
Mailing address:
  • Phone: 847-877-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: