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General NPI Number Information
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NPI Number | 1649402629
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Entity Type | Organization
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Legal Business Name | BATSON PEDIATRIC PHYSICAL THERAPY AND SPORT REHABILITATION
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 25753 W IVANHOE RD
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City | WAUCONDA
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State | IL
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Zip | 60084-2366
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Country | US
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Telephone | 847-254-1708
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Fax | 847-487-0759
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Provider Business Mailing Address
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Address Line | 25753 W IVANHOE RD
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City | WAUCONDA
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State | IL
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Zip | 60084-2366
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Country | US
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Telephone | 847-254-1708
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Fax | 847-487-2285
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. NICHOLAS AVELLINO BATSON
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Credential | P.T.
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Telephone | 847-254-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 213000023
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 070011615
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License Number State | IL
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