Provider Demographics
NPI:1992897425
Name:SILVER, JUSTIN (PT,MPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SILVER
Suffix:
Gender:M
Credentials:PT,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1657
Mailing Address - Country:US
Mailing Address - Phone:847-581-6300
Mailing Address - Fax:847-657-0408
Practice Address - Street 1:1824 JOHNS DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1657
Practice Address - Country:US
Practice Address - Phone:847-657-0400
Practice Address - Fax:847-657-0408
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013977225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25015Medicare PIN
ILK36828Medicare PIN