Functional Physical Therapy, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-011136 Issued in IL

Legal business name

FUNCTIONAL PHYSICAL THERAPY, INC

Practice address

369 W Army Trail Rd
Unit 14
Bloomingdale, IL 60108-2358

Phone

(630) 893-5534

Fax

(630) 893-5527

NPI assigned

May 17, 2006

Organization subpart

No

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

Authorized official

Name

Tim Francis Fedorski, PT, ATC

Title

President/Owner

Phone

(630) 893-5534

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

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

• Megan T Lausen, P.T.

  • Physical Therapist
  • Los Alamos, NM
  • NPI 1447430103
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1790738409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 S BLOOMINGDALE RD",
            "address_2": "UNIT 101",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081481",
            "telephone_number": "630-893-5534",
            "fax_number": "630-893-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 W ARMY TRAIL RD",
            "address_2": "UNIT 14",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601082358",
            "telephone_number": "630-893-5534",
            "fax_number": "630-893-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "FEDORSKI",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-893-5534",
        "authorized_official_credential": "PT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-011136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02232938",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DH0131",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00478856",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "352586282001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Anne Floro, PT
• Focus Care MD LTD
• Foot & Ankle Center
• Tamia Foster
• Chad Franche, DPT
• Frank B Fung, M.D.
• Elizabeth Gabzdyl, CNM
• Nichole Marie Gaddis, LCSW
• Rex Limon Gamisera, PT, DPT
• Perry Wilson Gamon, PTA

• Physical Therapist in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.