Organization
CARL GUSTAFSON LLC
Active
Other names
Sports and Physical Therapy Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN MCGIVERN (CHIEF COMPLIANCE OFFICER)
(630) 296-2222
Entity
Organization
Contact information
Practice address
2 LAUREL AVE, WELLESLEY, MA 02481-7523
(781) 237-5585
(781) 237-5633
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440
(630) 296-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/13/2006
Last updated
06/12/2017
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