Lynette Mae Carlson, DHS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

528 Issued in TN

Practice address

635 Executive Dr
Willowbrook, IL 60527-5603

Phone

(630) 455-6630

Fax

(630) 455-6631

NPI assigned

Feb 21, 2006

Sex

Female

Sole proprietor

Yes

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Athletic and Therapeutic Institute of Naperville, LLC

  • Physical Therapist
  • Willowbrook, IL
  • NPI 1144331794

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503964800000",
    "number": "1821063017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 STRINGERS RIDGE RD APT 2K",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374053238",
            "telephone_number": "630-674-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 EXECUTIVE DR",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275603",
            "telephone_number": "630-455-6630",
            "fax_number": "630-455-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "LYNETTE",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "DHS, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2017-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.002040",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Angelo Cannizzaro, DDS
• Mary J Cannon, M.D.
• Valbona Capani, FNP
• Joan T. Cardone, M.D.
• Nicole Cardott, PT, DPT
• Carla A Carpenter, D.O.
• Syreeta Monee Carter, LICSW
• Yolanda Castaneda, FNP-BC
• Center for Natural Therapies, LTD.
• Corinne Sullivan Cescolini, APRN

• All providers in Willowbrook, IL
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2017; 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.