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General NPI Number Information
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NPI Number | 1396078275
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Entity Type | Organization
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Legal Business Name | FUNTASTIC GYMNASTIC INC
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 401 S MILWAUKEE AVE SUITE 235
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 847-465-9556
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Fax | 847-465-9621
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Provider Business Mailing Address
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Address Line | 401 SOUTH MILWAUKEE AVE SUITE #235
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 847-465-9556
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Fax | 847-465-9621
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Authorized Official
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Title or Position | DIRECTOR
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Name | PATRICIA F OSTROW
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Credential |
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Telephone | 224-554-9634
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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