Provider Demographics
NPI:1417947763
Name:NORTHWEST CENTER FOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-297-7020
Mailing Address - Street 1:1400 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1431
Mailing Address - Country:US
Mailing Address - Phone:847-297-7020
Mailing Address - Fax:847-297-7022
Practice Address - Street 1:1400 N NORTHWEST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1431
Practice Address - Country:US
Practice Address - Phone:847-297-7020
Practice Address - Fax:847-297-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003103225100000X
IL070005817225100000X
IL070013859225100000X
IL070014321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL39148Medicare UPIN
ILK16572Medicare UPIN
ILL39147Medicare UPIN
ILK07671Medicare UPIN