Provider Demographics
NPI:1235103706
Name:MAYERSON, ROBERT MARK (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:MAYERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W TREEHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3597
Mailing Address - Country:US
Mailing Address - Phone:847-546-4368
Mailing Address - Fax:
Practice Address - Street 1:2601 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9780
Practice Address - Country:US
Practice Address - Phone:847-658-2500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960019322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL96001932OtherSTATE OF IL ATC LICENSE