Provider Demographics
NPI:1316989684
Name:THE SPORTS MEDICINE & REHABILITATION INSTITUTE P.C.
Entity type:Organization
Organization Name:THE SPORTS MEDICINE & REHABILITATION INSTITUTE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT OCS ATCL
Authorized Official - Phone:630-904-5530
Mailing Address - Street 1:PO BOX 5670
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5670
Mailing Address - Country:US
Mailing Address - Phone:630-904-5530
Mailing Address - Fax:630-904-5580
Practice Address - Street 1:5024 ACE LN
Practice Address - Street 2:SUITE 120
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8102
Practice Address - Country:US
Practice Address - Phone:630-904-5530
Practice Address - Fax:630-904-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060007208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205612Medicare UPIN