Provider Demographics
NPI:1497244859
Name:ATTENTIVE INDIVIDUALIZED MANAGEMENT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ATTENTIVE INDIVIDUALIZED MANAGEMENT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-853-2858
Mailing Address - Street 1:330B DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9800
Mailing Address - Country:US
Mailing Address - Phone:630-777-3141
Mailing Address - Fax:630-777-3142
Practice Address - Street 1:330B DIVISION DR
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-777-3141
Practice Address - Fax:630-777-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy