Healthcare Provider Details

I. General information

NPI: 1750206173
Provider Name (Legal Business Name): MIGHTY MOBILE KIDS PEDIATRIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 W IMLAY ST
CHICAGO IL
60631-1771
US

IV. Provider business mailing address

6960 W IMLAY ST
CHICAGO IL
60631-1771
US

V. Phone/Fax

Practice location:
  • Phone: 773-981-8996
  • Fax:
Mailing address:
  • Phone: 773-981-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE VIVERITO
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 773-981-8996