Provider Demographics
NPI:1215128863
Name:ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Entity type:Organization
Organization Name:ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGIVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
Mailing Address - Street 1:4947 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0049
Mailing Address - Country:US
Mailing Address - Phone:263-296-2223
Mailing Address - Fax:
Practice Address - Street 1:16651 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2581
Practice Address - Country:US
Practice Address - Phone:708-444-2467
Practice Address - Fax:708-444-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL612866201OtherDEPARTMENT OF LABOR PROVIDER NUMBER
IL216859Medicare PIN
IL612866201OtherDEPARTMENT OF LABOR PROVIDER NUMBER
ILDG0790Medicare PIN