Healthcare Provider Details

I. General information

NPI: 1003440025
Provider Name (Legal Business Name): AV PERFORMANCE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 JOHNS DR
GLENVIEW IL
60025-1657
US

IV. Provider business mailing address

924 BURNHAM CT
GLENVIEW IL
60025-4140
US

V. Phone/Fax

Practice location:
  • Phone: 224-334-3075
  • Fax:
Mailing address:
  • Phone: 847-989-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANTIGONE SOPHIA VESCI
Title or Position: OWNER
Credential: PT, DPT, ATC
Phone: 947-989-7207