Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Pettiway, MPT

Individual provider Physical Therapist · NPI 1023153558

Ethan Pettiway, MPT is a Physical Therapist in Private Practice in Chicago, Illinois. Qualified in 2005, 21 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
21
Licensed in
IL
In the registry since
2007
What do these letters mean?
MPT — Master of Physical Therapy
The master's-level physical therapy degree awarded before the DPT became standard.

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Practice location Address checks out

500 N Kingsbury St
Chicago, IL 60654-5721
Phone: (312) 527-5801
Fax: (312) 644-4567
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 070014987 (IL)

Record details

NPI number1023153558
Entity typeIndividual (Type 1)
GenderMale
Credentials MPT
Sole proprietorNo
NPI enumeratedFebruary 21, 2007
Last updated in NPPESDecember 1, 2009

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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