Provider Demographics
NPI:1427389501
Name:FUNCTIONAL & SPORTS PERFORMANCE, INC.
Entity Type:Organization
Organization Name:FUNCTIONAL & SPORTS PERFORMANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ZAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-303-0580
Mailing Address - Street 1:11 GLENOBLE CT
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1542
Mailing Address - Country:US
Mailing Address - Phone:630-303-0580
Mailing Address - Fax:
Practice Address - Street 1:11 GLENOBLE CT
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1542
Practice Address - Country:US
Practice Address - Phone:630-303-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy