Waddell Sports Rehab LLC

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

Legal business name

WADDELL SPORTS REHAB LLC

Practice address

9820 S Trumbull Ave
Evergreen Park, IL 60805-3049

Phone

(773) 307-7288

NPI assigned

Nov 8, 2023

Last updated

Nov 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Martin Waddell, DPTNPI 1184380792

Title

Owner

Phone

(773) 307-7288

Specialties & licenses 1

Addresses

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.

• Robert Martin Waddell, PT

  • Physical Therapist
  • Oak Lawn, IL
  • NPI 1184380792
  NPD Authorized official

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1972377273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9820 S TRUMBULL AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053049",
            "telephone_number": "773-307-7288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9820 S TRUMBULL AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053049",
            "telephone_number": "773-307-7288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADDELL SPORTS REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-08",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-307-7288",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physical Therapist in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Sports Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.