Provider Demographics
NPI:1114126794
Name:YENTER, KERWIN M (PT)
Entity Type:Individual
Prefix:MR
First Name:KERWIN
Middle Name:M
Last Name:YENTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3202
Mailing Address - Country:US
Mailing Address - Phone:312-909-9525
Mailing Address - Fax:
Practice Address - Street 1:16450 104TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5441
Practice Address - Country:US
Practice Address - Phone:708-364-8441
Practice Address - Fax:708-364-8443
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11544Medicare PIN