Provider Demographics
NPI:1902920333
Name:DEWITTE, CHAMBERLIN D (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHAMBERLIN
Middle Name:D
Last Name:DEWITTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43W481 KENMAR CT
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9106
Mailing Address - Country:US
Mailing Address - Phone:815-375-0132
Mailing Address - Fax:
Practice Address - Street 1:3300 RESOURCE PKWY
Practice Address - Street 2:SUITE #5
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-5334
Practice Address - Country:US
Practice Address - Phone:815-758-5508
Practice Address - Fax:815-758-5537
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47132Medicare PIN