Georgina Govostis, ATC
Individual provider Active NPI Athletic Trainer · Kildeer, IL
NPI 1992158190 · NPPES record last updated Jul 22, 2016
Key facts
- NPI
- 1992158190
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 096004190 (IL)
- Practice address
- 21727 N Timber Ridge CT
Kildeer, IL 60047-3301 - Phone
- (224) 636-6823
- NPI assigned
- Jul 22, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096004190 | IL | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096004190 | IL | Yes |
Addresses
Primary practice location
21727 N Timber Ridge CT
Kildeer, IL 60047-3301
Mailing address
21727 N Timber Ridge CT
Kildeer, IL 60047-3301
Other providers in Kildeer, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.