Provider Demographics
NPI:1285409730
Name:ATHLETE PERFORMANCE LLC
Entity type:Organization
Organization Name:ATHLETE PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBARNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-600-4200
Mailing Address - Street 1:3517 N NEVA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3632
Mailing Address - Country:US
Mailing Address - Phone:773-600-4200
Mailing Address - Fax:
Practice Address - Street 1:350 W KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1141
Practice Address - Country:US
Practice Address - Phone:773-600-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty