Provider Demographics
NPI:1003216383
Name:ROBERTS, TERRI (PT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:S TERRY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2625 BUTTERFIELD RD STE 300S
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1262
Mailing Address - Country:US
Mailing Address - Phone:630-573-1979
Mailing Address - Fax:630-573-1716
Practice Address - Street 1:2625 BUTTERFIELD RD STE 300S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1262
Practice Address - Country:US
Practice Address - Phone:630-573-1979
Practice Address - Fax:630-573-1716
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070003612OtherPHYSICAL THERAPY LICENSE