Lifesport Physical Therapy PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

LIFESPORT PHYSICAL THERAPY PC

Practice address

2000 N Racine Ave
Chicago, IL 60614-7006

Phone

(312) 330-1607

NPI assigned

Aug 16, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jon Williams, PTNPI 1811275282

Title

President

Phone

(312) 330-1607

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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

• Jon Michael Williams, PT, DPT

  • Physical Therapist
  • Chicago, IL
  • NPI 1811275282
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1881312874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 MONTGOMERY LN",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254924",
            "telephone_number": "312-330-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N RACINE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147006",
            "telephone_number": "312-330-1607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPORT PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-330-1607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifescan Chicago LLC
• Lifescan Labs of Illinois, LLC
• Lifescore Foundation
• Lifespan Behavioral Health P.C.
• Lifespan Neurodevelopmental Consultants
• Lifestart National Fitness
• Lifestyle Chiropractic PC
• Lifestyle Physical Therapy & Balance Center, PLLC
• Lifestyle Rejuvenation Medical Group PLLC
• Lifesync Health Inc

• Physical Therapy Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.