Provider Demographics
NPI:1043987720
Name:MAGELITZ, ARLEN NATHANIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ARLEN
Middle Name:NATHANIEL
Last Name:MAGELITZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17820 S DUEWER RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IL
Mailing Address - Zip Code:62692-8518
Mailing Address - Country:US
Mailing Address - Phone:217-303-3816
Mailing Address - Fax:
Practice Address - Street 1:2201 W WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6498
Practice Address - Country:US
Practice Address - Phone:217-546-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist