Provider Demographics
NPI:1184445827
Name:ASCENT ATHLETICS, LLC
Entity type:Organization
Organization Name:ASCENT ATHLETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, SCS
Authorized Official - Phone:309-533-2374
Mailing Address - Street 1:1440 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2849
Mailing Address - Country:US
Mailing Address - Phone:309-533-2374
Mailing Address - Fax:
Practice Address - Street 1:1440 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2849
Practice Address - Country:US
Practice Address - Phone:309-533-2374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy