Basic Information
Provider Information
NPI: 1164979811
EntityType: 2
ReplacementNPI:  
OrganizationName: ACCELERATED REHABILITATION CENTERS LTD
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ATHLETICO PHYSICAL THERAPY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 625 ENTERPRISE DR
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605238813
CountryCode: US
TelephoneNumber: 6305751932
FaxNumber: 6309285032
Practice Location
Address1: 1797 HILL RD N
Address2: SUITE 101
City: PICKERINGTON
State: OH
PostalCode: 431477996
CountryCode: US
TelephoneNumber: 6144940140
FaxNumber: 6144940141
Other Information
ProviderEnumerationDate: 09/09/2016
LastUpdateDate: 09/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COOK
AuthorizedOfficialFirstName: GERI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF BILLING OPERATIONS
AuthorizedOfficialTelephone: 6305751940
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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