MEDICARE: ATI HOLDINGS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	225100000X	Physical Therapist	MD
2	225X00000X	Occupational Therapist	MD
3	332B00000X	Durable Medical Equipment & Medical Supplies	MD

General Provider Information

NPI Number	:	1205246600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATI HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-3251

Provider Business Practice Location Address
First Line	:	137 W HIGH ST
Second Line	:	SUITE 3
City	:	ELKTON
State	:	MD
Zip	:	21921-8600
Country	:	US
Telephone Number	:	410-392-7027
Fax Number	:	410-392-5768

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	LYNN MCGIVERN
Credential	:
Telephone Number	:	630-296-2222

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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