Basic Information
| Provider Information | |||||||||
| NPI: | 1942200266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLIVATO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1936 W GRACE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606132726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123165910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 635 EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | WILLOW BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605275603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304556630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.