Provider Demographics
NPI:1457462053
Name:ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Entity Type:Organization
Organization Name:ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Other - Org Name:ATI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGIVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
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:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:4511 STATE ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7416
Practice Address - Country:US
Practice Address - Phone:630-554-7815
Practice Address - Fax:630-554-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04732021OtherBLUE CROSS BLUE SHIELD
IL611827600OtherDEPARTMENT OF LABOR PROVIDER NUMBER
IL7400622OtherAETNA
ILDD1797Medicare PIN
IL216860Medicare PIN
IL209796Medicare PIN