Benjamin Colletti, DAT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.005401 Issued in IL

Practice address

7628 Appletree LN
Willowbrook, IL 60527-2437

Phone

(630) 862-5060

NPI assigned

Feb 27, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1740720572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7628 APPLETREE LN",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272437",
            "telephone_number": "630-862-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7628 APPLETREE LN",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272437",
            "telephone_number": "630-862-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLETTI",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "DAT, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.005401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Willowbrook, IL
• Providers in Willowbrook, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.