Provider Demographics
NPI:1932844826
Name:ATHLETES PLACE, PLLC
Entity Type:Organization
Organization Name:ATHLETES PLACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-522-2336
Mailing Address - Street 1:4N970 E MARY DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5533
Mailing Address - Country:US
Mailing Address - Phone:708-522-2336
Mailing Address - Fax:
Practice Address - Street 1:333 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1573
Practice Address - Country:US
Practice Address - Phone:708-522-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy