Randy C Bugayong, PT
Individual provider Active NPI Physical Therapist · Winnetka, IL
NPI 1508517020 · NPPES record last updated Jan 17, 2022
Key facts
- NPI
- 1508517020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070-007310 (IL)
- Practice address
- 852 Green Bay Rd
Winnetka, IL 60093-1853 - Phone
- (847) 441-5788
- Fax
- (847) 784-8720
- NPI assigned
- Jan 17, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-007310 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-007310 | IL | Yes |
Addresses
Primary practice location
852 Green Bay Rd
Winnetka, IL 60093-1853
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980
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All providers in Winnetka, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.