Provider Demographics
NPI:1942200266
Name:ALLIVATO, JAMES JOHN JR (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOHN
Last Name:ALLIVATO
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2726
Mailing Address - Country:US
Mailing Address - Phone:312-316-5910
Mailing Address - Fax:
Practice Address - Street 1:635 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:WILLOW BROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5603
Practice Address - Country:US
Practice Address - Phone:630-455-6630
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer