Provider Demographics
NPI:1104391028
Name:ADAPT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:ADAPT PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Other - Org Name:UNBROKEN REHAB AND ATHLETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:SAMPANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:847-293-8171
Mailing Address - Street 1:5536 N ARTESIAN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3992
Mailing Address - Country:US
Mailing Address - Phone:847-293-8171
Mailing Address - Fax:
Practice Address - Street 1:125 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3663
Practice Address - Country:US
Practice Address - Phone:847-773-0298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-07
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy