Provider Demographics
NPI:1568627552
Name:ANTARES INSTITUTE OF INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:ANTARES INSTITUTE OF INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-321-2296
Mailing Address - Street 1:545 PLAINFIELD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7600
Mailing Address - Country:US
Mailing Address - Phone:630-321-2296
Mailing Address - Fax:
Practice Address - Street 1:545 PLAINFIELD RD
Practice Address - Street 2:SUITE E
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7600
Practice Address - Country:US
Practice Address - Phone:630-321-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 163WL0100X, 171100000X, 225700000X
IL070008189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty