Provider Demographics
NPI:1245424464
Name:ATHLETIC & THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC
Entity Type:Organization
Organization Name:ATHLETIC & THERAPEUTIC INSTITUTE OF MILWAUKEE, LLC
Other - Org Name:ATI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2223
Mailing Address - Street 1:4947 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0049
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-6106
Practice Address - Street 1:10945 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5078
Practice Address - Country:US
Practice Address - Phone:262-241-6777
Practice Address - Fax:262-241-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36191100Medicaid
WI611826604OtherDEPARTMENT OF LABOR PROVIDER NUMBER
WI000083042Medicare PIN