Modern Athlete Physical Therapy LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

MODERN ATHLETE PHYSICAL THERAPY LLC

Practice address

1033 Progress Dr
Grayslake, IL 60030-1672

Phone

(847) 257-5172

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Michael Todd Bitzer, PTNPI 1396745675

Title

Owner, Physical Therapist

Phone

(847) 257-5172

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Todd Bitzer, PT

  • Orthopedic Physical Therapist
  • Grayslake, IL
  • NPI 1396745675
  NPD Authorized official

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1346859477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 LYNN DR",
            "city": "HAWTHORN WOODS",
            "state": "IL",
            "postal_code": "600479102",
            "telephone_number": "847-257-5172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 PROGRESS DR",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301672",
            "telephone_number": "847-257-5172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ATHLETE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "BITZER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "847-257-5172",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriela Miniscalco, PSYD
• Gabriela Miranda
• Wajahat Mirza, MD
• Erin Joyce Mister
• Maral Mjukian
• Elizabeth Modzelewski
• Jenean Moore, M.A., LCPC
• Margaret S Moraw, OTR/L
• Erica Viridiana Moreno, LSW
• Fatima Moreno

• Orthopedic Physical Therapist in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.