Unknown Individual – Physical Therapist, NPI 1013393859

Unknown Individual is a healthcare provider. based in Bolingbrook, Illinois. specializing in Physical Therapist. They hold a License No. 1262868 (TX). The NPI Number for Unknown Individual is 1013393859

Main info

Organization
Inactive
11 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013393859
Phone
(630) 296-2223
Address
790 REMINGTON BLVD
Deactivation Date
12 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2106816681
Graduation Year
2015 (11 years ago)
PAC ID
6709194657
Group Practice PAC ID
0547583809
Professional Enrollment ID
I20151110001066
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 790 REMINGTON BLVD

    BOLINGBROOK, IL 604404909

    Phone: (630) 296-2223

    Fax: (630) 759-9510

    Type: Mailing

  • 3124 SIDNEY BROOKS ST

    570B

    SAN ANTONIO, TX 782355113

    Phone: (210) 593-0578

    Fax: (210) 614-3216

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60440)

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Provider's Procedures

Unknown Individual performs procedures in Physical Therapist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICAL THERAPYTX97110Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes152551
PHYSICAL THERAPYTX97140Manual (physical) therapy techniques to 1 or more regions, each 15 minutes44845

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0547583809View full group profile
NameSpecialtyState
Occupational Therapist In Private PracticeTX
-IL
Physical Therapist In Private PracticeIL
-TN
-TX
-TX
Occupational Therapist In Private PracticeTX
-TX
Physical Therapist In Private PracticeTX
Physical Therapist In Private PracticeIL

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1013393859.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Physical Therapist. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Bolingbrook, Illinois?
For routing, start with Bolingbrook, Illinois for Unknown Individual, then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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