Provider Demographics
NPI:1598946063
Name:ATHLETIC & THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Entity Type:Organization
Organization Name:ATHLETIC & THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Other - Org Name:ATI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOVICH
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:630-296-2222
Mailing Address - Fax:630-759-6106
Practice Address - Street 1:1065 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3567
Practice Address - Country:US
Practice Address - Phone:815-588-1366
Practice Address - Fax:815-588-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356148917OtherDEPARTMENT OF LABOR PROVIDER NUMBER
IL356148917OtherDEPARTMENT OF LABOR PROVIDER NUMBER
IL202845Medicare PIN
IL215695Medicare PIN