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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