FUNTASTIC GYMNASTIC LLC (NPI# 1396078275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396078275 |
| Entity Type | Organization |
| Organization Name | FUNTASTIC GYMNASTIC LLC |
| Other Organization Name | THE AUTISM THERAPY GROUP |
| Practice Address |
401 S. Milwaukee Ave Suite 235 Wheeling IL 60090 |
| Practice Telephone | 8474659556 |
| Practice Fax Number | 8474659621 |
| Mailing Telephone | 8474659556 |
| Mailing Fax Number | 8474659621 |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2019-03-07 |
| Authorized Official Name | MR. MARK JACKSON (CEO) |
| Authorized Official Telephone | 2245095608 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| Y | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Funtastic Gymnastic LLC | Former Legal Business Name - Organization |
| The Autism Therapy Group | Doing Business As Name - Organization |
| Street Address |
401 S. MILWAUKEE AVE SUITE 235 |
| City | WHEELING |
| State | IL |
| Zip Code | 60090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164062493 | Annemarie Catherine Barter | Behavioral Analyst | 401 S. Milwaukee Ave, Suite 235, Wheeling, IL 60090 | 2020-01-15 |
| 1598046641 | Sue Ellen Burns | Speech-Language Pathologist | 401 S. Milwaukee Ave, Suite 210, Wheeling, IL 60090-5072 | 2011-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003320318 | Suhani Shail Shah | Pharmacist | Broadway Ave Pharmacy, 151 N 19th Ave, Melrose Park, IL 60090 | 2017-11-22 |
| 1164933479 | Vilija Ball | Psychologist | 307 S Milwaukee Ave Ste 103, Wheeling, IL 60090 | 2017-10-13 |
| 1184143117 | Jeremy Holtmeier | Psychologist | Wheeling School District 21, 999 West Dundee Road, Wheeling, IL 60090 | 2017-09-11 |
| 1326589128 | Nicole Tinetti | Student in an Organized Health Care Education/Training Program | 1410 Marcy Ln, Wheeling, IL 60090 | 2017-03-13 |
| 1881065365 | Melissa Theresa Ballak | Pharmacist | 1400 E Lake-cook Road, Wheeling, IL 60090 | 2015-10-09 |
| 1083031249 | Medtec Healthcare & Private Duty, LLC | Clinic/Center | 43 W Dundee Rd, Wheeling, IL 60090 | 2014-03-26 |
| 1508137464 | Kras Medical S.c. | Dentist | 1532 West Lale Cook Road, Wheeling, IL 60090 | 2012-01-24 |
| 1629351077 | Kedvon Pharmacy Solutions, Inc. | Durable Medical Equipment & Medical Supplies | 56 South Milwaukee Ave., Wheeling, IL 60090 | 2011-09-22 |
| 1992038814 | Ida Neyman | Specialist | 45 Prairie Park Dr., Apt 503, Wheeling, IL 60090 | 2009-09-10 |
| 1083841449 | Family Dental Enter Chicago | Clinic/Center | 2710 W Devon Ave. 3rd Floor, Wheeling, IL 60090 | 2009-06-12 |
| Find all providers in zip 60090 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982202057 | Tiffany Renee Beck | Behavioral Analyst | 1007 Market Street, Wheeling, WV 26003 | 2020-10-12 |
| 1891327227 | Violet Rak | Behavioral Analyst | 401 S Milwaukee Ave Ste 235, Wheeling, IL 60090-5098 | 2020-02-04 |
| 1649781071 | Haley Rauschenberg | Behavioral Analyst | 1007 Market St, Wheeling, WV 26003-2911 | 2017-10-12 |
| 1831610773 | Teri Hunley-woolwine | Behavioral Analyst | 143 Smith Ln, Wheeling, WV 26003-7822 | 2017-06-30 |
| 1407397060 | Vicky P Ryan | Behavioral Analyst | 1032 Kenilworth Dr, Wheeling, IL 60090-3918 | 2017-03-15 |
| 1497141295 | Elise Oliver | Behavioral Analyst | 554 Old Fairmont Pike, Wheeling, WV 26003-4635 | 2015-04-09 |
| 1598363400 | Deidre Kathleen Barlip | Behavioral Analyst | 1007 Market St, Wheeling, WV 26003-2911 | 2020-10-13 |
| 1336747443 | Ashley Whitlatch | Behavioral Analyst | 1007 Market St, Wheeling, WV 26003-2911 | 2020-10-12 |
| 1013515121 | Katelyn Braho | Behavioral Analyst | 1007 Market St, Wheeling, WV 26003-2911 | 2020-10-12 |
| 1700484862 | Kylie Abagail Sellman | Behavioral Analyst | 1007 Market St, Wheeling, WV 26003-2911 | 2020-10-12 |
| Find all providers in WHEELING | ||||
Please comment or provide details below to improve the information on FUNTASTIC GYMNASTIC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.