Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carlo Custodio Cordero, PT

Individual provider Physical Therapist · NPI 1407211501

Carlo Custodio Cordero, PT is a Physical Therapist in Private Practice in Lockport, Illinois. Qualified in 2011, 15 years ago. Practices with Athletic and Therapeutic Institute of Bourbonnais, LLC, a 170-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
15
Licensed in
IL
In the registry since
2015
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

1065 E 9th St
Lockport, IL 60441-3567
Phone: (815) 588-1366
Fax: (815) 588-2010
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1899 Norwich Ln, Bolingbrook, IL 60490-5515 — (815) 909-9491

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 070.020489 (IL)

Record details

NPI number1407211501
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedDecember 16, 2015
Last updated in NPPESOctober 10, 2025
Certification dateOctober 10, 2025
Mailing address2001 Butterfield Rd Ste 1600, Downers Grove, IL 60515-1211

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Athletic And Therapeutic Institute Of Bourbonnais, Llc — 170 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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