Provider Demographics
NPI:1861524092
Name:BOEBEL, MATTHEW D (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:BOEBEL
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 1:923 FERDINAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2201
Mailing Address - Country:US
Mailing Address - Phone:708-366-5193
Mailing Address - Fax:
Practice Address - Street 1:5601 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4875
Practice Address - Country:US
Practice Address - Phone:630-286-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700105372251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics