Provider Demographics
NPI:1093013377
Name:FUNTASTIC INC.
Entity Type:Organization
Organization Name:FUNTASTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-507-5960
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-0373
Mailing Address - Country:US
Mailing Address - Phone:847-507-5960
Mailing Address - Fax:847-986-4055
Practice Address - Street 1:1020 CASTLEWOOD LN
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2646
Practice Address - Country:US
Practice Address - Phone:847-507-5960
Practice Address - Fax:847-986-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy