Carlo Custodio Cordero, PT
Individual provider Active NPI Physical Therapist · Lockport, IL
NPI 1407211501 · NPPES record last updated Oct 10, 2025
Key facts
- NPI
- 1407211501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070.020489 (IL)
- Practice address
- 1065 E 9TH St
Lockport, IL 60441-3567 - Phone
- (815) 588-1366
- Fax
- (815) 588-2010
- NPI assigned
- Dec 16, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athletic and Therapeutic Institute of Bourbonnais, LLC
Practice addresses (Care Compare)
1065 E 9TH St
Lockport, IL 60441-3567
Phone (815) 588-1366
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230711003657 | IL | Practitioner - Physical Therapist in Private Practice | 1153780911 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.020489 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletic & Therapeutic Institute of Bourbonnais, LLC | Physical Therapist | Current |
Accepting new patients |
| Athletic and Therapeutic Institute of Bourbonnais, LLC | Physical Therapist | Current |
Accepting new patients |
| Athletic and Therapeutic Institute of Bourbonnais, LLC | Physical Therapist | Current | Accepting new patients |
Locations
383 W Army Trail Rd
Ste 100
Bloomingdale, IL 60108
Phone (630) 924-0367
1275 N Convent St
Ste 3
Bourbonnais, IL 60914
Phone (815) 936-1855
4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001
2001 Butterfield Rd
Ste 1600
Downers Grove, IL 60515
1065 E 9th St
Lockport, IL 60441
Phone (815) 588-1366
2081 Ridge Rd
Ste 101
Minooka, IL 60447
Phone (815) 467-1612
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.020489 | IL | Yes |
Addresses
Primary practice location
1065 E 9TH St
Lockport, IL 60441-3567
Mailing address
2001 Butterfield Rd Ste 1600
Downers Grove, IL 60515-1211
Phone (866) 370-8206
Other practice location 1
1899 Norwich Ln
Bolingbrook, IL 60490-5515
Phone (815) 909-9491
Other providers in Lockport, IL
- Jacqueline Cikowski
- Daniel Lee Clark
- Daniel R Co
- Loretta L Colhardt
- Comfort Your Way
- Richard A Craig
- Eileen Mary Crean
- Joseph William Cunnane
- Kristine D Czaplicki
- Jeffrey John D'Adam
All providers in Lockport, 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 Oct 10, 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.