Healthcare Provider Details

I. General information

NPI: 1154877116
Provider Name (Legal Business Name): L3 ARTISTIC ATHLETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 BENTLEY AVE
WILLOWBROOK IL
60527-1962
US

IV. Provider business mailing address

6231 BENTLEY AVE
WILLOWBROOK IL
60527-1962
US

V. Phone/Fax

Practice location:
  • Phone: 630-222-8469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.018609
License Number StateIL

VIII. Authorized Official

Name: DR. BRITTANY LAPINSKI
Title or Position: OWNER/PHYSICAL THERAPIST
Credential:
Phone: 630-222-8469