Active NPI
Michele L. Ontiveros, PT, MBA
- Physical Therapist
- Highland Park, IL
National Provider Identifier
1740451673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070009037
- Practice address
- 1601 Green Bay Road
Highland Park, IL 60035 - Phone
- (847) 926-7255
- NPI assigned
- Mar 19, 2008
- 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 | 070009037 | IL | Primary |
Addresses
Primary practice location
1601 Green Bay Road
Highland Park, IL 60035
Mailing address
1601 Green Bay Rd
Highland Park, IL 60035-3522
Phone (847) 926-7255
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
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070009037 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359590400000",
"number": "1740451673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 GREEN BAY RD",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "600353522",
"telephone_number": "847-926-7255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 GREEN BAY ROAD",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "60035",
"telephone_number": "847-926-7255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ONTIVEROS",
"first_name": "MICHELE",
"middle_name": "L.",
"credential": "PT, MBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-19",
"last_updated": "2013-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070009037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.