MEDICARE: MATTHEW WINDMOELLER 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	PT4532	ME
2	225100000X	Physical Therapist	070023479	IL

General Provider Information

NPI Number	:	1942685789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WINDMOELLER DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1731 HENRY LUCKOW LN
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-1702
Country	:	US
Telephone Number	:	815-544-6967
Fax Number	:

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

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	03/26/2021

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