Provider Demographics
NPI:1982435921
Name:LEW, NICHOLAS CONRAD (PT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:CONRAD
Last Name:LEW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 N YORK ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-6001
Mailing Address - Country:US
Mailing Address - Phone:630-832-6919
Mailing Address - Fax:630-832-1512
Practice Address - Street 1:183 N YORK ST STE A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-6001
Practice Address - Country:US
Practice Address - Phone:630-832-6919
Practice Address - Fax:630-832-1512
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist