Provider Demographics
NPI:1659509578
Name:VENKATESAN, SREETHAR (DPT)
Entity Type:Individual
Prefix:
First Name:SREETHAR
Middle Name:
Last Name:VENKATESAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BUCKTHORN TERRACE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1832
Mailing Address - Country:US
Mailing Address - Phone:630-854-1593
Mailing Address - Fax:
Practice Address - Street 1:604 BUCKTHORN TERRACE
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1832
Practice Address - Country:US
Practice Address - Phone:630-854-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019564225100000X
TX1311723225100000X
IL070017530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist