Provider Demographics
NPI:1962038604
Name:ADRAHTAS, ARISTIDIS JOHN (ATC, MS)
Entity Type:Individual
Prefix:
First Name:ARISTIDIS
Middle Name:JOHN
Last Name:ADRAHTAS
Suffix:
Gender:M
Credentials:ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2525
Mailing Address - Country:US
Mailing Address - Phone:847-529-4399
Mailing Address - Fax:
Practice Address - Street 1:2501 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5902
Practice Address - Country:US
Practice Address - Phone:773-534-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0043042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer