AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE — NPI 1104494194 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1104494194

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

43W481 KENMAR CT, ELBURN, IL, 60119-9106

✓ 9-Digit EDI 837 ZIP+4 (60119-9106)

Practice Phone & Referral Fax

(815) 375-0132

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104494194 (AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104494194` (NPI-2 Organization / Facility)
Provider / Legal Name	AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	43W481 KENMAR CT, ELBURN, IL, 60119-9106
Practice Telephone / Fax	Tel: (815) 375-0132
Administrative Mailing Address	43W481 KENMAR CT, ELBURN, IL, 60119-9106
Enumeration & Last Sync	Enumerated: 2021-06-15 \| CMS Record Updated: 2021-06-15
Authorized Official	CHAMBERLIN DEWITTE (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

43W481 KENMAR CT, ELBURN, IL, 60119-9106

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AWAKEN PHYSICAL THERAPY AND MYOFASCIAL RELEASE (NPI #1104494194)