NPIMap

Organization Active NPI

Theracore, Inc.

  • Physical Therapist
  • Lockport, IL
National Provider Identifier
1043481005
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
THERACORE, INC.
Practice address
16622 W 159TH St
Suite 503
Lockport, IL 60441-8014
Phone
(815) 838-5070
NPI assigned
Mar 18, 2008
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Goebbert, DPTNPI 1134263403
Title
President
Phone
(630) 204-2977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

16622 W 159TH St
Suite 503
Lockport, IL 60441-8014

Mailing address

16622 W 159TH St
Suite 503
Lockport, IL 60441-8014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080623000455 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9234200049 Receives reassigned benefits from 7 practitioners
Practice locations: Lockport, IL; Westmont, IL

National Provider Directory

National Provider Directory

Locations

16622 W 159th St
Ste 503
Lockport, IL 60441
Phone (815) 838-5070

220 W Ogden Ave
Westmont, IL 60559
Phone (630) 908-7430

220 W Ogden Ave
Ste 200
Westmont, IL 60559

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1043481005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16622 W 159TH ST",
            "address_2": "SUITE 503",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16622 W 159TH ST",
            "address_2": "SUITE 503",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604418014",
            "telephone_number": "815-838-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERACORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-18",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "GOEBBERT",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-204-2977",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lockport, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.