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General NPI Number Information
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NPI Number | 1316818354
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Entity Type | Organization
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Legal Business Name | CORE SPORT AND PHYSICAL THERAPY DOWNERS GROVE PLLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 5203 THATCHER RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4027
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Country | US
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Telephone | 773-307-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 10224 S KEDZIE AVE STE C
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3700
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Country | US
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Telephone | 773-307-7288
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST AND CO-OWNER
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Name | ROBERT WADDELL
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Credential | DPT
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Telephone | 773-307-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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