Organization
MODERN ATHLETE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TODD BITZER PT (OWNER, PHYSICAL THERAPIST)
(847) 257-5172
Entity
Organization
Contact information
Practice address
1033 PROGRESS DR, GRAYSLAKE, IL 60030-1672
(847) 257-5172
Mailing address
32 LYNN DR, HAWTHORN WOODS, IL 60047-9102
(847) 257-5172
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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