Provider Demographics
NPI:1760653463
Name:REYHER, TENNILLE R (PT)
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:R
Last Name:REYHER
Suffix:
Gender:F
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 1:850 W JACKSON BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3032
Practice Address - Country:US
Practice Address - Phone:312-491-0934
Practice Address - Fax:312-491-0935
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568150OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP
ILR00976Medicare PIN
IL568150OtherMEDICARE GROUP NUMBER
ILR00974Medicare PIN