Provider Demographics
NPI:1710233960
Name:THURBER, TONYA M (DPT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:THURBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:M
Other - Last Name:LEGROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1916
Mailing Address - Fax:630-928-5016
Practice Address - Street 1:4749 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4301
Practice Address - Country:US
Practice Address - Phone:414-281-1380
Practice Address - Fax:414-281-1381
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11973-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI803580003OtherMEDICARE PTAN