Core Sport & Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

CORE SPORT & PHYSICAL THERAPY PLLC

Practice address

10224 S Kedzie Ave Unit C
Evergreen Park, IL 60805-3735

Phone

(773) 941-6132

NPI assigned

Aug 19, 2024

Organization subpart

Yes

Parent organization

CORE FITNESS & PHYSICAL THERAPY INC.As reported in NPPES

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

Authorized official

Name

Diane Fidler, PHYSICAL THERAPIST

Title

Owner

Phone

(773) 510-6422

Specialties & licenses 1

Addresses

Part of

Core Fitness Physical Therapy Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Core Fitness & Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Evergreen Park, IL
  • NPI 1356507024
  NPPES parent name

Practitioners 3

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

• Jared Gonzales

  • Physical Therapist
  • Evergreen Park, IL
  • NPI 1679454482
  NPD
• Christopher James Johnston, DPT

  • Physical Medicine & Rehabilitation Physician
  • Evergreen Park, IL
  • NPI 1588499958
  NPD
• Robert Martin Waddell, PT

  • Physical Therapist
  • Oak Lawn, IL
  • NPI 1184380792
  NPD

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1376375394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052408",
            "telephone_number": "708-422-0990",
            "fax_number": "708-741-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10224 S KEDZIE AVE UNIT C",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053735",
            "telephone_number": "773-941-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE SPORT & PHYSICAL THERAPY PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORE FITNESS & PHYSICAL THERAPY INC.",
        "enumeration_date": "2024-08-19",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "FIDLER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-510-6422",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Consultants in Cardiology & Electrophysiololgy LLC
• Consultants in Clinical Pathology
• Consultants in Laboratory Medicine and Pathology, LTD.
• Peggy Lynn Cook, RN
• Core Fitness & Physical Therapy Inc.
• Karen M Costello, PT
• Siobhan T. Cotter, O.T.
• Natalia Adriana Cotton, PA-C
• Jennifer Courts, APN
• Lashonda Marie Cox, RN

• Physical Therapist in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; 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.