Agne Velicka, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070027026 Issued in IL

Practice address

720 Roosevelt Rd
Glen Ellyn, IL 60137-5806

Phone

(630) 984-2200

NPI assigned

Oct 3, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revolution PTWL LLCGroup PAC ID 7719115617, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Revolution PTWL LLC

  • Physical Therapist
  • Chicago, IL
  • NPI 1164766606
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1861116972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 FLOYD BROWN LN APT 2A",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392985",
            "telephone_number": "847-602-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375806",
            "telephone_number": "630-984-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2216 W North Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606476494",
            "country_code": "US",
            "telephone_number": "312-586-1184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1595 Floyd Brown Ln Apt 2A",
            "address_purpose": "LOCATION",
            "city": "Glendale Heights",
            "state": "IL",
            "postal_code": "601392985",
            "country_code": "US",
            "telephone_number": "630-340-8018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELICKA",
        "first_name": "AGNE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070027026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "avelicka@revolutionptwl.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "720 Roosevelt Rd",
            "city": "Glen Ellyn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601375806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.