Active NPI
Renee Heelan, PT
- Physical Therapist
- Gurnee, IL
National Provider Identifier
1912950841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 350 S Greenleaf St
Suite 405
Gurnee, IL 60031-5709 - Phone
- (847) 596-7640
- NPI assigned
- May 19, 2006
- 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 | IL | Primary |
Addresses
Primary practice location
350 S Greenleaf St
Suite 405
Gurnee, IL 60031-5709
Mailing address
8930 Waukegan Rd
Suite 200 - Attn: Raquel Leon
Morton Grove, IL 60053-2126
Phone (847) 324-3976
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 |
|---|---|---|---|
| 070-004041 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188259200000",
"number": "1912950841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8930 WAUKEGAN RD",
"address_2": "SUITE 200 - ATTN: RAQUEL LEON",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600532126",
"telephone_number": "847-324-3976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 S GREENLEAF ST",
"address_2": "SUITE 405",
"city": "GURNEE",
"state": "IL",
"postal_code": "600315709",
"telephone_number": "847-596-7640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEELAN",
"first_name": "RENEE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2007-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.