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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	610078609	OTHER	IL	DEPT OF LABOR

General Provider Information

NPI Number	:	1871825455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-728-2690
Fax Number	:	773-728-2692

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	LYNN MCGIVERN
Credential	:
Telephone Number	:	630-296-2222

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	04/06/2011

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