Unknown Individual – Physical Therapist, NPI 1093990525

Unknown Individual is a healthcare provider. based in Bolingbrook, Illinois. specializing in Physical Therapist. They hold a License No. 070-016089 (IL). The NPI Number for Unknown Individual is 1093990525

Main info

Organization
Inactive
19 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093990525
Phone
(630) 296-2222
Address
790 REMINGTON BLVD
Deactivation Date
9 August 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7089383378
Graduation Year
2007 (19 years ago)
PAC ID
5991863284
Group Practice PAC ID
9133484694
Professional Enrollment ID
I20081014000710
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

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Provider Addresses for Unknown Individual

  • 790, Remington Boulevard, Bolingbrook, Will County, Illinois, 60440, United States

    BOLINGBROOK, IL 604404909

    Phone: (630) 296-2222

    Fax: (630) 759-9510

    Type: Mailing

  • 12052, South Cicero Avenue, Hazel Green, Alsip, Worth Township, Cook County, Illinois, 60803, United States

    ALSIP, IL 608032313

    Phone: (708) 489-9940

    Fax: (708) 489-9961

    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 THERAPYIL97110Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes1365124

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: 9133484694View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeAZ
Registered Dietitian Or Nutrition ProfessionalIL
Physical Therapist In Private PracticeIL
Clinical Social WorkerIL
Physical Therapist In Private PracticeIL
Physical Therapist In Private PracticeIL
Registered Dietitian Or Nutrition ProfessionalIL
Physical Therapist In Private PracticeIL
Clinical Social WorkerNY
Registered Dietitian Or Nutrition ProfessionalIL

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1093990525.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Physical Therapist. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Bolingbrook, Illinois for Unknown Individual; expand the address list for detail.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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