Healthcare Provider Details

I. General information

NPI: 1982327458
Provider Name (Legal Business Name): PEDIATRIC POST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E TERRA COTTA AVE # 237-244
CRYSTAL LAKE IL
60014-3649
US

IV. Provider business mailing address

820 E TERRA COTTA AVE # 237-244
CRYSTAL LAKE IL
60014-3649
US

V. Phone/Fax

Practice location:
  • Phone: 847-338-4463
  • Fax: 224-678-0036
Mailing address:
  • Phone: 815-354-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ALLY STEVENS
Title or Position: PTA
Credential: PTA
Phone: 815-354-8200