Provider Demographics
NPI:1104010354
Name:OSBORNE, CHAD R (PT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S WABASH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2491
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:7191 S KINGERY HWY
Practice Address - Street 2:SUITE L6
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5525
Practice Address - Country:US
Practice Address - Phone:630-455-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03195-1225100000X
MA19228225100000X
IL070015891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00757069OtherMEDICARE RAILROAD
IL216859212Medicare PIN
ILP00757069OtherMEDICARE RAILROAD
ILK53166Medicare PIN
ILK41293Medicare PIN
IL211585005Medicare PIN
ILK45562Medicare PIN
ILK53167Medicare PIN