=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992616239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUSTIN DANIEL NOBBE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1698 S ELMHURST RD STE 110
-----------------------------------------------------
City | MOUNT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-786-2014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3407 ROYAL WOODS DR
-----------------------------------------------------
City | CRYSTAL LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60014-4799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-355-1986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 160.020768
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------