Provider Demographics
NPI:1043502917
Name:TENEROW WALKER, MEREDITH (PT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:TENEROW WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:TENEROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1015 E SONGSMITH DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1194
Practice Address - Country:US
Practice Address - Phone:302-836-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010777A225100000X
DEJ10002685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1043502917Medicaid
DE218571Y0XMedicare PIN