Provider Demographics
NPI:1508194952
Name:ALLIED THERAPY NETWORK, INC.
Entity Type:Organization
Organization Name:ALLIED THERAPY NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASICLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-858-9000
Mailing Address - Street 1:1155 N MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3508
Mailing Address - Country:US
Mailing Address - Phone:630-858-9000
Mailing Address - Fax:630-858-2421
Practice Address - Street 1:1155 N MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3508
Practice Address - Country:US
Practice Address - Phone:630-858-9000
Practice Address - Fax:630-858-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy