MEDICARE: REENA THOMAS MATHEW DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070023276	IL

General Provider Information

NPI Number	:	1033645940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REENA THOMAS MATHEW DPT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	834 N ELMHURST RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1132
Country	:	US
Telephone Number	:	847-215-7200
Fax Number	:	847-215-7900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	08/17/2023

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