Active NPI
Mary Kathleen Phelan, PT, DPT
- Physical Therapist
- Chicago, IL
National Provider Identifier
1366818239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.021582
- Practice address
- 345 E Superior St
Chicago, IL 60611-2654 - Phone
- (312) 238-1000
- NPI assigned
- Aug 14, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.021582 | IL | Primary |
Addresses
Primary practice location
345 E Superior St
Chicago, IL 60611-2654
Mailing address
10904 S Kenneth Ave
Oak Lawn, IL 60453-5727
Phone (708) 912-2821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.021582 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439510400000",
"number": "1366818239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10904 S KENNETH AVE",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604535727",
"telephone_number": "708-912-2821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 E SUPERIOR ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112654",
"telephone_number": "312-238-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "MARY",
"middle_name": "KATHLEEN",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-14",
"last_updated": "2015-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.021582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.