| Organization Name: | INNOVATIVE SPORTS MEDICINE LLC |
| NPI Number: | 1881963163 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC HESTRUP (MEMBER) |
| Mailing Address: | 501 W Fabyan Pkwy Batavia |
| State: | IL US |
| Postal Code: | 605101267 |
| Phone Number: | 6305242445 |
| Fax Number: | |
| NPI Enumeration Date: | 12/15/2011 |
| NPI Last Update Date: | 05/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070019008 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |