Basic Information
| Provider Information | |||||||||
| NPI: | 1265597157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC | ||||||||
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| OtherOrganizationName: | ATHLETIC AND THERAPEUTIC INSTITUTE OF WINFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4947 PAYSHPERE CIRCEL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
| FaxNumber: | 6307596106 | ||||||||
| Practice Location | |||||||||
| Address1: | 0 SOUTH 050 WINFIELD ROAD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306534743 | ||||||||
| FaxNumber: | 6306534912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | BOGOVICH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6302962222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 356148902 | 01 | IL | DEPARTMENT OF LABOR PROVIDER NUMBER | OTHER |