Provider Demographics
NPI:1780832782
Name:REID, MICHAEL J (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:REID
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 LAKEVIEW PARKWAY
Mailing Address - Street 2:STE 195
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-247-7200
Mailing Address - Fax:847-247-4340
Practice Address - Street 1:935 LAKEVIEW PARKWAY
Practice Address - Street 2:STE 195
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-247-7200
Practice Address - Fax:847-247-4340
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist