Individual provider Active NPI

Elizabeth Kehoe, MPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1073655890
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070014293 Issued in IL
Practice address
5240 N Pulaski Rd Ste N
Chicago, IL 60630-1761
Phone
(773) 267-6922
Fax
(773) 267-6925
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070014293 IL Primary

Addresses

Primary practice location

5240 N Pulaski Rd Ste N
Chicago, IL 60630-1761

Mailing address

625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 575-6250

Other names 1

  • Elizabeth Dallas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200205002322 WI Practitioner - Physical Therapist in Private Practice 8820254576 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nissenbaum and Schleusner Pro Physical Therapy LLCGroup PAC ID 2668753070, 14 clinicians

Practice addresses (Care Compare)

1118 Main St
Suite a
Cross Plains, WI 53528-9477
Phone (608) 658-6890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol Physical Therapy LLC Physical Therapist CurrentSince Jan 6, 2020 Accepting new patients
Nissenbaum and Schleusner Pro Physical Therapy LLC Physical Therapist CurrentSince Mar 9, 2020 Accepting new patients
Nissenbaum and Schleusner Pro Physical Therapy LLC Physical Therapist CurrentSince Mar 9, 2020 Accepting new patients
Nissenbaum and Schleusner Pro Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

1118 Main St
#A
Cross Plains, WI 53528
Phone (608) 413-0550

711 Rethke Ave
Ste 1
Madison, WI 53714
Phone (608) 841-1290

1709 Monroe St
Madison, WI 53711
Phone (608) 509-8298

2248 Deming Way
Ste 100
Middleton, WI 53562
Phone (608) 658-5352

6649 University Ave
#100
Middleton, WI 53562
Phone (608) 836-0305

1215 Springdale St
Mount Horeb, WI 53572
Phone (608) 437-0222

530 Water St
Sauk City, WI 53583
Phone (608) 413-0550

1266 W Main St
Sun Prairie, WI 53590
Phone (608) 318-1357

972 W Main St
Sun Prairie, WI 53590
Phone (608) 318-0052

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073655890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-6250",
            "fax_number": "630-575-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5240 N PULASKI RD STE N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301761",
            "telephone_number": "773-267-6922",
            "fax_number": "773-267-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEHOE",
        "first_name": "ELIZABETH",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070014293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "DALLAS",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.