Provider Demographics
NPI:1760413181
Name:SILLEVIS, ROBERT J (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SILLEVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 S LAKE PARK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5961
Mailing Address - Country:US
Mailing Address - Phone:219-945-1538
Mailing Address - Fax:219-945-0151
Practice Address - Street 1:1265 S LAKE PARK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5961
Practice Address - Country:US
Practice Address - Phone:219-945-1538
Practice Address - Fax:219-945-0151
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004153225100000X
FLPT27361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200216870Medicaid
IN000000093614OtherANTHEM BCBS
IL05004153AOtherBCBS ILLINOIS
IN200216870Medicaid
FLGG006ZMedicare PIN
INP00285363Medicare PIN