Awaken Physical Therapy and Myofascial Release

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE

Practice address

43W481 Kenmar CT
Elburn, IL 60119-9106

Phone

(815) 375-0132

NPI assigned

Jun 15, 2021

Last updated

Jun 15, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chamberlin Dewitte, PTNPI 1902920333

Title

Owner

Phone

(815) 375-0132

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chamberlin D Dewitte, PT

  • Physical Therapist
  • Dekalb, IL
  • NPI 1902920333
  NPD Authorized official

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1104494194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43W481 KENMAR CT",
            "city": "ELBURN",
            "state": "IL",
            "postal_code": "601199106",
            "telephone_number": "815-375-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43W481 KENMAR CT",
            "city": "ELBURN",
            "state": "IL",
            "postal_code": "601199106",
            "telephone_number": "815-375-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "DEWITTE",
        "authorized_official_first_name": "CHAMBERLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-375-0132",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Accelerated Rehabilitation Centers, LTD (Athletico Physical Therapy)
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• American Drug Stores LLC (Osco Pharmacy)
• Axon Bodywork Therapies LLC (Axon Medical Massage Therapy)
• William Paul Barron, RPH
• Anne Barsch, MA, LMFT
• Kenneth Ervin Baumruck, D.C.
• Michael Billett

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.