Engram

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ENGRAM

Doing business as

Engram Therapy and Wellness Clinic

Practice address

2655 W Peterson Ave
Chicago, IL 60659-4017

Phone

(630) 729-4344

NPI assigned

Sep 8, 2021

Organization subpart

Yes

Parent organization

ENGRAMAs reported in NPPES

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

Authorized official

Name

Carla Mae R Haverland, PT, GCSNPI 1184899072

Title

Ceo

Phone

(630) 729-4344

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Engram Therapy and Wellness Clinic Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Part of

Engram

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carla Mae Haverland, PT

  • Physical Therapist
  • Chicago, IL
  • NPI 1184899072
  Medicare reassignment NPD Authorized official
• Maria Cecilia Rivera, PT

  • Physical Therapist
  • Arlington Heights, IL
  • NPI 1760293203
  Medicare reassignment NPD
• Amanda R Lorenz, PHD

  • Clinical Psychologist
  • Skokie, IL
  • NPI 1912952623
  NPD

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1295404820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017",
            "telephone_number": "630-729-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594017",
            "telephone_number": "630-729-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENGRAM",
        "enumeration_date": "2021-09-08",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "HAVERLAND",
        "authorized_official_first_name": "CARLA MAE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-729-4344",
        "authorized_official_credential": "PT, GCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184899072",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chaverland@engramtherapy.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2655 W Peterson Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606594017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Engram Therapy and Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary E English, D.C.
• Tontania M. English, RN
• Kristin V Englund, MA
• Elizabeth Engman, MD
• Sophia Marlee Engman
• Enhanced Physical Therapy
• Enida Haxhia DDS Ms PLLC
• Enio a Rigolin MD SC
• Enkindle Counseling PLLC
• Enlighten Holistic Medicine, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.