Provider Demographics
NPI:1437266848
Name:NORTHWEST SUBURBAN PHYSICAL THERAPY LTD
Entity Type:Organization
Organization Name:NORTHWEST SUBURBAN PHYSICAL THERAPY LTD
Other - Org Name:DOUGLAS H MEHLAN PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:MEHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-490-0435
Mailing Address - Street 1:2200 W HIGGINS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-490-0435
Mailing Address - Fax:847-490-0560
Practice Address - Street 1:2200 W HIGGINS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-490-0435
Practice Address - Fax:847-490-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL344425841001Medicaid
IL344425841001Medicaid