Provider Demographics
NPI:1801864111
Name:WATOR, JOHN A (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:WATOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:WATOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:18219 CLEAR CREEK XING
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5238
Mailing Address - Country:US
Mailing Address - Phone:708-479-9284
Mailing Address - Fax:
Practice Address - Street 1:18219 CLEAR CREEK XING
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5238
Practice Address - Country:US
Practice Address - Phone:708-479-9284
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960000612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer