Justin Gibson
Individual provider Active NPI Physical Therapist · Winnetka, IL
NPI 1053112482 · NPPES record last updated Mar 21, 2025
Key facts
- NPI
- 1053112482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 852 Green Bay Rd
Winnetka, IL 60093-1853 - Phone
- (847) 441-5788
- NPI assigned
- Mar 21, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athletico LTD
Practice addresses (Care Compare)
852 Green Bay Rd
Winnetka, IL 60093-1853
Phone (847) 441-5788
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251001000137 | IL | Practitioner - Physical Therapist in Private Practice | 4082110846 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
Locations
280 N Randall Rd
Lake in the Hills, IL 60156
Phone (847) 854-8219
2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250
722 N McLean Blvd
South Elgin, IL 60177
Phone (847) 695-5088
852 Green Bay Rd
Winnetka, IL 60093
Phone (847) 441-5788
Interoperability endpoints
- justin.gibson.p9@direct.athleticoltd.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Yes |
Addresses
Primary practice location
852 Green Bay Rd
Winnetka, IL 60093-1853
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Other providers in Winnetka, IL
- Michael Kevin Gaynor
- Arshad Gazi
- Mary Geiser
- George F. Warga DDS
- Paul Getzendanner
- Paige Golden
- Jennifer Goldstein
- Rena Goodfriend-Leve
- Rachel Goodman
- Ronna Gordon
All providers in Winnetka, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.