Basic Information
Provider Information
NPI: 1366746232
EntityType: 2
ReplacementNPI:  
OrganizationName: APPLE PHYSICAL THERAPY LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ATI PHYSICAL THERAPY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 790 REMINGTON BLVD
Address2:  
City: BOLINGBROOK
State: IL
PostalCode: 604404909
CountryCode: US
TelephoneNumber: 6302962223
FaxNumber: 6307599510
Practice Location
Address1: 6601 220TH ST SW
Address2: SUITE 1
City: MOUNTLAKE TERRACE
State: WA
PostalCode: 980432166
CountryCode: US
TelephoneNumber: 4257757274
FaxNumber: 4257750963
Other Information
ProviderEnumerationDate: 01/06/2011
LastUpdateDate: 03/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MCGIVERN
AuthorizedOfficialFirstName: LYNN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CCO
AuthorizedOfficialTelephone: 6302962222
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X  Y SuppliersDurable Medical Equipment & Medical Supplies 

No ID Information.


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