Provider Demographics
NPI:1407882442
Name:STANWOOD, MICHAEL (PT, ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STANWOOD
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42-46 E STREET RD
Practice Address - Street 2:STORE 505
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:610-399-8600
Practice Address - Fax:610-399-8601
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001056225100000X
PAPT011355L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1456769OtherPABS
284043OtherPA BS
DE1000037720Medicaid
0706621000OtherAMERIHEALTH
PA064506VKFMedicare PIN
284043OtherPA BS
DE010464F68Medicare ID - Type Unspecified
PA064506MYXMedicare ID - Type Unspecified
DEG02378A19Medicare PIN