Provider Demographics
NPI:1740761246
Name:ATKENSON, MEREDITH A (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:ATKENSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MORGAN ST APT 515
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2729
Mailing Address - Country:US
Mailing Address - Phone:708-710-6646
Mailing Address - Fax:
Practice Address - Street 1:1002 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1317
Practice Address - Country:US
Practice Address - Phone:773-248-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist