Provider Demographics
NPI:1174637094
Name:MADGWICK, WENDY D (PT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:D
Last Name:MADGWICK
Suffix:
Gender:F
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:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-0681
Mailing Address - Country:US
Mailing Address - Phone:847-622-3860
Mailing Address - Fax:847-266-1512
Practice Address - Street 1:1898 1ST ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3102
Practice Address - Country:US
Practice Address - Phone:847-622-3860
Practice Address - Fax:847-266-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004932393OtherBCBS PROVIDER NUMBER
IL0081641234OtherBCBS PROVIDER NUMBER