MEDICARE: NORTHWESTERN MEDICINE

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1205763885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN MEDICINE

Provider Business Mailing Address
First Line	:	1215 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3127
Country	:	US
Telephone Number	:	312-694-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 N STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3820
Country	:	US
Telephone Number	:	630-933-1500
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	CY WHITLER
Credential	:	DPT
Telephone Number	:	270-931-0162

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “NORTHWESTERN MEDICINE ” Practice Location

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