Organization Active NPI

North Shore Spinal & Sports Rehabilitation, LTD

  • Physical Therapist
  • Highland Park, IL
National Provider Identifier
1508088030
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NORTH SHORE SPINAL & SPORTS REHABILITATION, LTD
Practice address
1770 1St St Ste 100
Highland Park, IL 60035-3210
Phone
(847) 432-4077
Fax
(847) 681-8940
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Authorized official

Name
David Andrew Johnson, PT, DPTNPI 1154482008
Title
Director
Phone
(847) 432-4077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X IL Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

1770 1St St Ste 100
Highland Park, IL 60035-3210

Mailing address

1770 1St St Ste 100
Highland Park, IL 60035-3210
Phone (847) 432-4077

Other names 2

  • North Shore Spinal & Sports Rehabilitation Doing business as
  • North Shore Spinal and Sports Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000204 IL Part B Supplier - Clinic/Group Practice 2163412453 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Highland Park, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1770 1st St
Ste 100
Highland Park, IL 60035
Phone (847) 432-4077

100 E Scranton Ave
Lake Bluff, IL 60044
Phone (847) 295-0920

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782432000000",
    "number": "1508088030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 1ST ST STE 100",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353210",
            "telephone_number": "847-432-4077",
            "fax_number": "847-681-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 1ST ST STE 100",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353210",
            "telephone_number": "847-432-4077",
            "fax_number": "847-681-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE SPINAL & SPORTS REHABILITATION, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-432-4077",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Spinal & Sports Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore Spinal and Sports Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; 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.