# BATSON PEDIATRIC PHYSICAL THERAPY AND SPORT REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nicholas A. Batson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649402629
- **Authorized official:** MR. NICHOLAS AVELLINO BATSON P.T. (OWNER/MANAGER)
- **Authorized official phone:** (847) 254-1708

## Contact information

- **Practice address:** 25753 W IVANHOE RD, WAUCONDA, IL 60084-2366
- **Practice address phone:** (847) 254-1708
- **Practice address fax:** (847) 487-0759
- **Mailing address:** 25753 W IVANHOE RD, WAUCONDA, IL 60084-2366
- **Mailing address phone:** (847) 254-1708
- **Mailing address fax:** (847) 487-2285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246Z00000X | Other Specialist/Technologist | 070011615 | IL | Yes |
| 246Z00000X | Other Specialist/Technologist | 213000023 | IL | — |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 08/10/2009
- **Last updated:** 08/10/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110624814001 | — | IL |