Provider Demographics
NPI:1659340784
Name:RENTFRO, BREE ANN (MS, PTA, ATC)
Entity Type:Individual
Prefix:MISS
First Name:BREE
Middle Name:ANN
Last Name:RENTFRO
Suffix:
Gender:F
Credentials:MS, PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16015 APPLEWOOD LN APT 107
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-3184
Mailing Address - Country:US
Mailing Address - Phone:708-845-1904
Mailing Address - Fax:
Practice Address - Street 1:100 197TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-7539
Practice Address - Country:US
Practice Address - Phone:708-755-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001825225200000X
IL960011642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer