# FUNTASTIC GYMNASTIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Autism Therapy Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396078275
- **Authorized official:** MR. MARK JACKSON (CEO)
- **Authorized official phone:** (224) 509-5608

## Contact information

- **Practice address:** 991 OAK CREEK DR, LOMBARD, IL 60148-6408
- **Practice address phone:** (847) 465-9556
- **Mailing address:** 991 OAK CREEK DR, LOMBARD, IL 60148-6408
- **Mailing address phone:** (847) 465-9556
- **Mailing address fax:** (847) 465-9621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 09/10/2009
- **Last updated:** 05/10/2025