Provider Demographics
NPI:1114143799
Name:BENDER, D. JONATHAN (PT)
Entity Type:Individual
Prefix:
First Name:D. JONATHAN
Middle Name:
Last Name:BENDER
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:24014 W RENWICK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8708
Practice Address - Country:US
Practice Address - Phone:815-577-2488
Practice Address - Fax:815-577-2489
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBS OF ILOther1619980
ILR03551Medicare PIN
ILK09975Medicare PIN
IL568150Medicare PIN
ILR03550Medicare PIN
IL567700Medicare PIN
IL568080Medicare PIN