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NPI Code Detail

MEDICARE: ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC

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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101635177OTHERILBLUE CROSS BLUE SHIELD
2610078600OTHERILDEPARTMENT OF LABOR PROVIDER NUMBER
37320697OTHERILAETNA

General Provider Information

NPI Number : 1922119510
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Provider Business Mailing Address
First Line : 4947 PAYSPHERE CIR
Second Line :
City : CHICAGO
State : IL
Zip : 60674-0049
Country : US
Telephone Number : 630-296-2222
Fax Number :
Provider Business Practice Location Address
First Line : 5616 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-5511
Country : US
Telephone Number : 773-526-5239
Fax Number : 773-526-5240
Authorized Official
Title or Position : CHIEF COMPLIANCE OFFICER
Name : LYNN MCGIVERN
Credential :
Telephone Number : 630-296-2222
Provider Enumeration Date : 08/31/2006
Last Update Date : 04/07/2011

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Directions to “ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC ” Practice Location

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