Matthew J Govednik

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.008221 Issued in IL

Practice address

300 E Mazon Ave
Dwight, IL 60420-1104

Phone

(815) 584-1240

NPI assigned

Feb 5, 2019

Last updated

Feb 5, 2019By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1194280024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 W BERGERA RD",
            "city": "BRAIDWOOD",
            "state": "IL",
            "postal_code": "604081657",
            "telephone_number": "815-302-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E MAZON AVE",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201104",
            "telephone_number": "815-584-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOVEDNIK",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.008221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Dwight, IL
• Providers in Dwight, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; 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.