MEDICARE: CAMERON ROORDA 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	070.029809	IL

General Provider Information

NPI Number	:	1720926223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON ROORDA DPT

Provider Business Mailing Address
First Line	:	1443 W WABANSIA AVE # 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-1523
Country	:	US
Telephone Number	:	219-934-7274
Fax Number	:	773-943-6384

Provider Business Practice Location Address
First Line	:	1443 W WABANSIA AVE # 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-1523
Country	:	US
Telephone Number	:	219-934-7274
Fax Number	:	773-943-6384

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ CAMERON ROORDA DPT” Practice Location

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