Unknown Individual – Physical Therapist, NPI 1174562797

Unknown Individual is a healthcare provider. based in Plainfield, Illinois. specializing in Physical Therapist. They hold a License No. 5501004092 (MI). The NPI Number for Unknown Individual is 1174562797

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174562797
Phone
(800) 974-4378
Address
24014 W RENWICK RD STE F
Deactivation Date
18 September 2025

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
7347898281
Graduation Year
1989 (37 years ago)
PAC ID
4284524778
Group Practice PAC ID
5890685713
Professional Enrollment ID
I20040318000273
Data current as of
19 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

  • 24014 W RENWICK RD STE F

    PLAINFIELD, IL 605448708

    Phone: (800) 974-4378

    Fax: (630) 515-1536

    Type: Mailing

  • Telegraph Road, Flat Rock, Wayne County, Michigan, 48134, United States

    FLAT ROCK, MI 481349656

    Phone: (800) 974-4378

    Fax: (630) 515-1536

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes3311$0
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Insurance plans in this area (ZIP 60544)

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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 THERAPYMI97001Physical therapy evaluation3735

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: 5890685713View full group profile
NameSpecialtyState
-MI

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1174562797 is assigned to Unknown Individual under the national enumeration system.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Physical Therapist. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Plainfield, Illinois for Unknown Individual; expand the address list for detail.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1174562797. Always confirm identity and privileges with the practice and licensing boards.

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