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NPI Code Detail

MEDICARE: DR. NATHAN DEBLAUW DPT

MEDICARE: DR. NATHAN DEBLAUW 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
1225100000XPhysical Therapist070025121IL

General Provider Information

NPI Number : 1083228654
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN DEBLAUW DPT
Provider Business Mailing Address
First Line : 1214 W LOYOLA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60626-5102
Country : US
Telephone Number : 773-274-1769
Fax Number : 773-274-1937
Provider Business Practice Location Address
First Line : 1214 W LOYOLA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60626-5102
Country : US
Telephone Number : 773-274-1769
Fax Number : 773-274-1937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2020
Last Update Date : 09/01/2020

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