Active NPI
Timothy Song, DPT
- Physical Therapist
- Evanston, IL
National Provider Identifier
1639849573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.026208
- Practice address
- 909 Davis St Ste 220
Evanston, IL 60201-3664 - Phone
- (847) 733-7906
- NPI assigned
- Sep 13, 2021
- Sex
- Male
- 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 | 070.026208 | IL | Primary |
Addresses
Primary practice location
909 Davis St Ste 220
Evanston, IL 60201-3664
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.026208 | IL | MD | Physical Therapist |
Interoperability endpoints
- timothy.song.p9@direct.athleticoltd.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1639849573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2122 YORK RD STE 300",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605231925",
"telephone_number": "630-575-1980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 DAVIS ST STE 220",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013664",
"telephone_number": "847-733-7906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "TIMOTHY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-13",
"last_updated": "2021-11-11",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.026208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.