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General NPI Number Information
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NPI Number | 1861524092
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Entity Type | Individual
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Provider Name | MATTHEW D BOEBEL P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5601 S COUNTY LINE RD
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City | HINSDALE
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State | IL
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Zip | 60521-4875
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Country | US
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Telephone | 630-286-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 923 FERDINAND AVE
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City | FOREST PARK
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State | IL
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Zip | 60130-2201
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Country | US
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Telephone | 708-366-5193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 070010537
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License Number State | IL
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