NPIMap

Organization Active NPI

Athletic Edge Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Chicago, IL
National Provider Identifier
1124326038
Registry record updated Jun 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070015130 Issued in IL
Legal business name
ATHLETIC EDGE PHYSICAL THERAPY LLC
Practice address
1319 S Michigan Ave
Chicago, IL 60605-2601
Phone
(312) 617-5949
Fax
(312) 447-0036
NPI assigned
Mar 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2011

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

Authorized official

Name
Mr. Daniel L Gray
Title
Ceo
Phone
(312) 617-5949

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 070015130 IL
Physical Therapy Clinic/Center 261QP2000X 070015130 IL Primary

Addresses

Primary practice location

1319 S Michigan Ave
Chicago, IL 60605-2601

Mailing address

1319 S Michigan Ave
Chicago, IL 60605-2601
Phone (312) 617-5949

National Provider Directory

National Provider Directory

Locations

1319 S Michigan Ave
Chicago, IL 60605
Phone (312) 617-5949

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307318400000",
    "number": "1124326038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052601",
            "telephone_number": "312-617-5949",
            "fax_number": "312-447-0036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052601",
            "telephone_number": "312-617-5949",
            "fax_number": "312-447-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETIC EDGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-06-06",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-617-5949",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070015130",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070015130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; 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.