Organization
BATSON PEDIATRIC PHYSICAL THERAPY AND SPORT REHABILITATION
Active
Other names
Nicholas A. Batson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS AVELLINO BATSON P.T. (OWNER/MANAGER)
(847) 254-1708
Entity
Organization
Contact information
Practice address
25753 W IVANHOE RD, WAUCONDA, IL 60084-2366
(847) 254-1708
(847) 487-0759
Mailing address
25753 W IVANHOE RD, WAUCONDA, IL 60084-2366
(847) 254-1708
(847) 487-2285
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
070011615
IL
246Z00000X
Other Specialist/Technologist
213000023
IL
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110624814001
—
IL
Enumeration date
08/10/2009
Last updated
08/10/2009
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