Provider Demographics
NPI:1407977259
Name:LEWAN, MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEWAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:TRENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5040
Practice Address - Street 1:1600 16TH ST
Practice Address - Street 2:STE T14
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1302
Practice Address - Country:US
Practice Address - Phone:630-572-9700
Practice Address - Fax:630-572-0706
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist