Provider Demographics
NPI:1205893682
Name:ATOR, RITA DENISE (PT ATC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:DENISE
Last Name:ATOR
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 W HAPPY VALLEY RD STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2898
Practice Address - Country:US
Practice Address - Phone:623-322-0654
Practice Address - Fax:623-322-0664
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960002752255A2300X
AZ30477225100000X
IL070005288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53181Medicare PIN
ILL87347Medicare ID - Type UnspecifiedCOOK
ILK47336Medicare PIN
ILL80124Medicare ID - Type UnspecifiedDUPAGE WILL COUNTY
ILK53180Medicare PIN
ILK04736Medicare ID - Type UnspecifiedKENDALL