Rehab and Sports Med Outfitters, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

056005093 Issued in IL

Legal business name

REHAB AND SPORTS MED OUTFITTERS, INC

Practice address

312 Morgan Valley Dr
Oswego, IL 60543-8038

Phone

(630) 383-9404

NPI assigned

Jul 1, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Mark P Naso, O.T.

Title

Ceo

Phone

(630) 383-9404

Specialties & licenses 1

Addresses

Other names 1

• Rehab and Sports Med Outfitters of Fox Valley Former legal business name

Locations

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1114300654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 KIRKLAND CIR STE H",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438068",
            "telephone_number": "630-383-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 MORGAN VALLEY DR",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438038",
            "telephone_number": "630-383-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHAB AND SPORTS MED OUTFITTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "NASO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-383-9404",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.T."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "056005093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehab and Sports Med Outfitters of Fox Valley",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinic/Center in Oswego, IL
• Providers in Oswego, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.