Mateusz Wesolowski, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070026866 Issued in IL

Practice address

602 S Neil St
Champaign, IL 61820-5475

Phone

(217) 649-0504

Fax

(217) 253-8511

NPI assigned

Sep 28, 2022

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Impact Physical Therapy, LLCGroup PAC ID 2466998398, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Impact Physical Therapy, LLC

  • Physical Therapist
  • Chicago, IL
  • NPI 1508622614
  Medicare reassignment Care Compare group NPD
• Ipt Management Services, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Chicago, IL
  • NPI 1063868206

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1063136588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618205475",
            "telephone_number": "217-649-0504",
            "fax_number": "217-253-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618205475",
            "telephone_number": "217-649-0504",
            "fax_number": "217-253-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESOLOWSKI",
        "first_name": "MATEUSZ",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070026866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Charles Wennberg, B.A.
• Judith Werckle
• Wertz Chiropractic LTD
• Mark E. Wertz, D.C.
• Melody Wesley
• Casey West, PT, DPT, ATC, LAT
• Jenee Westjohn
• Paul Wetstein, M.D.
• Bryant Whalen
• Helen Katharine Whatley Pope, LMT, CZB

• Physical Therapist in Champaign, IL
• Providers in Champaign, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.