NPIMap

Organization Active NPI

Northwestern University Intercollegiate Sports Medicine

  • Physical Therapy Clinic/Center
  • Evanston, IL
National Provider Identifier
1750612115
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
NORTHWESTERN UNIVERSITY INTERCOLLEGIATE SPORTS MEDICINE
Practice address
2703 Ashland Ave
Northwestern University Sports Medicine
Evanston, IL 60208-0001
Phone
(847) 467-6791
Fax
(847) 491-8865
NPI assigned
Jan 26, 2010
Last updated
Apr 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Authorized official

Name
Lisa Krantz, PT, ATC
Title
Rehabilitation Coordinator
Phone
(847) 467-6791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2703 Ashland Ave
Northwestern University Sports Medicine
Evanston, IL 60208-0001

Mailing address

2703 Ashland Ave
Northwestern University Sports Medicine
Evanston, IL 60208-0001
Phone (847) 467-6791

National Provider Directory

National Provider Directory
Tax ID family
Northwestern Univ Pro O R7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2703 Ashland Ave
Evanston, IL 60208
Phone (847) 467-6791

NPI Registry JSON

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1750612115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2703 ASHLAND AVE",
            "address_2": "NORTHWESTERN UNIVERSITY SPORTS MEDICINE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080001",
            "telephone_number": "847-467-6791",
            "fax_number": "847-491-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2703 ASHLAND AVE",
            "address_2": "NORTHWESTERN UNIVERSITY SPORTS MEDICINE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602080001",
            "telephone_number": "847-467-6791",
            "fax_number": "847-491-8865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN UNIVERSITY INTERCOLLEGIATE SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "KRANTZ",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "REHABILITATION COORDINATOR",
        "authorized_official_telephone_number": "847-467-6791",
        "authorized_official_credential": "PT, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.