Basic Information
| Provider Information | |||||||||
| NPI: | 1972221703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATI HOLDINGS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663708206 | ||||||||
| FaxNumber: | 5174353670 | ||||||||
| Practice Location | |||||||||
| Address1: | 3420 CRAIN HWY UNIT 3410 | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207161302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402067941 | ||||||||
| FaxNumber: | 2402406866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2022 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONTRERAS | ||||||||
| AuthorizedOfficialFirstName: | IRMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6302962222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.