Provider Demographics
NPI:1992471148
Name:OSTERGAARD, ADAM K (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:K
Last Name:OSTERGAARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2924
Mailing Address - Country:US
Mailing Address - Phone:815-353-0731
Mailing Address - Fax:
Practice Address - Street 1:7106 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2924
Practice Address - Country:US
Practice Address - Phone:815-353-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist