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Organization
FUNTASTIC GYMNASTIC LLC
Active
Organization
FUNTASTIC GYMNASTIC LLC
Active
Other names
The Autism Therapy Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JACKSON (CEO)
(224) 509-5608
Entity
Organization
Contact information
Practice address
991 OAK CREEK DR, LOMBARD, IL 60148-6408
(847) 465-9556
Mailing address
991 OAK CREEK DR, LOMBARD, IL 60148-6408
(847) 465-9556
(847) 465-9621
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
09/10/2009
Last updated
05/10/2025
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