1962149518 NPI number — ON THE GO PEDIATRIC THERAPY

Table of content: (NPI 1962149518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962149518 NPI number — ON THE GO PEDIATRIC THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON THE GO PEDIATRIC THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962149518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1724 JULIET LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-323-8386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 N WILKE RD STE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60004-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-513-0613
Provider Business Practice Location Address Fax Number:
847-510-0491
Provider Enumeration Date:
05/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
LOKSA
Authorized Official First Name:
CLARE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
224-513-0613

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 331889259001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com