Provider Demographics
NPI:1679048086
Name:PINEDA, RENDELL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RENDELL
Middle Name:
Last Name:PINEDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 LINDA CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4724
Mailing Address - Country:US
Mailing Address - Phone:224-522-9944
Mailing Address - Fax:
Practice Address - Street 1:1101 PEMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4222
Practice Address - Country:US
Practice Address - Phone:800-886-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist