Individual provider Active NPI

Lauren Nellamattathil, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1699184291
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.022172 Issued in IL
Practice address
3420 N Lincoln Ave
Chicago, IL 60657-1195
Phone
(773) 360-7287
Fax
(773) 570-4843
NPI assigned
Aug 7, 2014
Last updated
Jul 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.022172 IL Primary

Addresses

Primary practice location

3420 N Lincoln Ave
Chicago, IL 60657-1195

Mailing address

2440 M St NW Ste 316
Washington, DC 20037-1449
Phone (202) 659-2673

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160823001092 IL Practitioner - Physical Therapist in Private Practice 0446564728 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.022172ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic and Therapeutic Institute of Naperville LLC Physical Therapist Current Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC CurrentSince Aug 8, 2016 Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC Physical Therapist CurrentSince Aug 8, 2016 Accepting new patients
Impact Physical Therapy, LLC Physical Therapist CurrentSince Mar 3, 2024 Accepting new patients
Endurance Physical Therapy PLLC Physical Therapist CurrentSince Mar 18, 2024 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

1103 S State St
Ste 300
Chicago, IL 60605
Phone (312) 877-5101

3233 W Addison St
Chicago, IL 60618
Phone (773) 478-0496

3420 N Lincoln Ave
Chicago, IL 60657
Phone (773) 360-7287

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

800 Des Plaines Ave
Forest Park, IL 60130
Phone (708) 366-2442

2909 MacArthur Blvd
Northbrook, IL 60062
Phone (224) 300-6158

0S050 Winfield Rd
Ste 120
Winfield, IL 60190
Phone (630) 653-4743

Interoperability endpoints

  • Direct secure messaging: lauren.rossbach.1@12689.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1699184291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 M ST NW STE 316",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200371449",
            "telephone_number": "202-659-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571195",
            "telephone_number": "773-360-7287",
            "fax_number": "773-570-4843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLAMATTATHIL",
        "first_name": "LAUREN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-07",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.022172",
            "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 Jul 14, 2021; 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.