Provider Demographics
NPI:1235104571
Name:AMERICAN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:AMERICAN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:ROT
Authorized Official - Phone:630-717-6188
Mailing Address - Street 1:1840 SLIPPERY ROCK RD
Mailing Address - Street 2:BHARAT MALHOTRA
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-717-6188
Mailing Address - Fax:630-717-8842
Practice Address - Street 1:1783 SOUTH WASHINGTON
Practice Address - Street 2:AMERICAN PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-717-6188
Practice Address - Fax:630-717-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL588570Medicare ID - Type Unspecified