NPIMap

Organization Active NPI

Innovative Pediatric Therapy, Inc.

  • Early Intervention Provider Agency
  • Chicago, IL
National Provider Identifier
1841434636
Registry record updated Apr 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
070.013401 Issued in IL
Legal business name
INNOVATIVE PEDIATRIC THERAPY, INC.
Practice address
1908 N Mohawk St
Unit 22
Chicago, IL 60614-5220
Phone
(773) 677-3758
Fax
(312) 787-3072
NPI assigned
Apr 24, 2009
Last updated
Apr 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

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

Authorized official

Name
Todd M Brueck
Title
Office Manager
Phone
(773) 332-0403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 070.013401 IL Primary

Addresses

Primary practice location

1908 N Mohawk St
Unit 22
Chicago, IL 60614-5220

Mailing address

1908 N Mohawk St
Unit 22
Chicago, IL 60614-5220
Phone (773) 677-3758

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1841434636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 N MOHAWK ST",
            "address_2": "UNIT 22",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145220",
            "telephone_number": "773-677-3758",
            "fax_number": "312-787-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 N MOHAWK ST",
            "address_2": "UNIT 22",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145220",
            "telephone_number": "773-677-3758",
            "fax_number": "312-787-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PEDIATRIC THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "BRUECK",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-332-0403"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "070.013401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; 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.