Basic Information
Provider Information | |||||||||
NPI: | 1851785059 | ||||||||
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: | 6305756250 | ||||||||
FaxNumber: | 6305757450 | ||||||||
Practice Location | |||||||||
Address1: | 103 E KENT ST | ||||||||
Address2: |   | ||||||||
City: | STREATOR | ||||||||
State: | IL | ||||||||
PostalCode: | 613642221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8156731770 | ||||||||
FaxNumber: | 8156731772 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/25/2015 | ||||||||
LastUpdateDate: | 01/19/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COOK | ||||||||
AuthorizedOfficialFirstName: | GERI | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINICAL SERVICES | ||||||||
AuthorizedOfficialTelephone: | 6305751940 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.