Provider Demographics
NPI:1043481005
Name:THERACORE, INC.
Entity Type:Organization
Organization Name:THERACORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-204-2977
Mailing Address - Street 1:16622 W 159TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16622 W 159TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8014
Practice Address - Country:US
Practice Address - Phone:815-838-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty