Provider Demographics
NPI:1417667296
Name:SCHWARZROCK, MEAGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:SCHWARZROCK
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 1:1333 W BELMONT AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5785
Mailing Address - Country:US
Mailing Address - Phone:312-926-8810
Mailing Address - Fax:312-694-9361
Practice Address - Street 1:1333 W BELMONT AVE STE 350
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5785
Practice Address - Country:US
Practice Address - Phone:312-926-8810
Practice Address - Fax:312-694-9361
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist