Healthcare Provider Details

I. General information

NPI: 1467677716
Provider Name (Legal Business Name): ALTIORA PEDIATRIC SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LEONARD PKWY
CRYSTAL LAKE IL
60014-5209
US

IV. Provider business mailing address

615 LEONARD PKWY
CRYSTAL LAKE IL
60014-5209
US

V. Phone/Fax

Practice location:
  • Phone: 815-893-0789
  • Fax: 815-893-0789
Mailing address:
  • Phone: 815-893-0789
  • Fax: 815-893-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. MONICA J FIEDLER
Title or Position: PRESIDENT, PHYSICAL THERAPIST
Credential: PT
Phone: 815-893-0789