Provider Demographics
NPI:1467677716
Name:ALTIORA PEDIATRIC SERVICES,INC.
Entity Type:Organization
Organization Name:ALTIORA PEDIATRIC SERVICES,INC.
Other - Org Name:EQUITUNEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-893-0789
Mailing Address - Street 1:615 LEONARD PKWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5209
Mailing Address - Country:US
Mailing Address - Phone:815-893-0789
Mailing Address - Fax:815-893-0789
Practice Address - Street 1:615 LEONARD PKWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5209
Practice Address - Country:US
Practice Address - Phone:815-893-0789
Practice Address - Fax:815-893-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
226300000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty