Provider Demographics
NPI:1780100313
Name:SPROUT THERAPY, LLC
Entity type:Organization
Organization Name:SPROUT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:INGLESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-235-0516
Mailing Address - Street 1:807 BERNADETTE LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3511
Mailing Address - Country:US
Mailing Address - Phone:630-235-0516
Mailing Address - Fax:
Practice Address - Street 1:807 BERNADETTE LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3511
Practice Address - Country:US
Practice Address - Phone:630-235-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty