Carlo Custodio Cordero, PT
NPI 1407211501ActiveIndividual· Physical Therapist· Lockport, IL
Physical Therapist (PT) with Athletic and Therapeutic Institute of Bourbonnais, LLC, practicing in Lockport, Illinois. Medicare paid $117,845 for services to 41 patients in 2024.
Overview
| NPI | 1407211501 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT |
| Sole proprietor | No |
| NPI issued | Dec 16, 2015 |
| Last updated in NPPES | Oct 10, 2025 |
| Certified by provider | Oct 10, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 070.020489 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (IL) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 41 |
|---|---|
| Services billed | 6,336 across 8 procedure codes |
| Paid by Medicare | $117,845 |
Education and affiliations
| Graduation year | 2011 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Athletic and Therapeutic Institute of Bourbonnais, LLCBourbonnais, IL · 167 clinicians
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All 31 physical therapists in Lockport · All physical therapists in Illinois