Healthcare Provider Details

I. General information

NPI: 1548202336
Provider Name (Legal Business Name): ACTIVE MOTION PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 E CHICAGO AVE
NAPERVILLE IL
60540-5915
US

IV. Provider business mailing address

1466 E CHICAGO AVE
NAPERVILLE IL
60540-5915
US

V. Phone/Fax

Practice location:
  • Phone: 630-544-5187
  • Fax: 630-544-5190
Mailing address:
  • Phone: 630-544-5187
  • Fax: 630-544-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number060-008854
License Number StateIL

VIII. Authorized Official

Name: CURTIS ADAM KNIGHT
Title or Position: PRESIDENT
Credential: P.T.
Phone: 630-544-5187