MEDICARE: ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	356148902	OTHER	IL	DEPARTMENT OF LABOR PROVIDER NUMBER

General Provider Information

NPI Number	:	1265597157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC

Provider Business Mailing Address
First Line	:	4947 PAYSHPERE CIRCEL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0001
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-6106

Provider Business Practice Location Address
First Line	:	0 SOUTH 050 WINFIELD ROAD
Second Line	:	SUITE 120
City	:	WINFIELD
State	:	IL
Zip	:	60190
Country	:	US
Telephone Number	:	630-653-4743
Fax Number	:	630-653-4912

Authorized Official
Title or Position	:	CFO
Name	:	MARK BOGOVICH
Credential	:
Telephone Number	:	630-296-2222

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	03/04/2009

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