Provider Demographics
NPI:1861475220
Name:BARON, THERESA M (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:BARON
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:HELNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:2777 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3280
Practice Address - Country:US
Practice Address - Phone:630-326-8810
Practice Address - Fax:630-326-8813
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4433-024225100000X
WI62-0392255A2300X
IL070-016793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000080070OtherMEDICARE GROUP NUMBER
WIP00248075OtherRAILROAD MEDICARE
ILP00920594OtherMEDICARE RAILROAD
WI180070Medicare ID - Type Unspecified
WI000080070OtherMEDICARE GROUP NUMBER
ILF400172157Medicare PIN
WIQ10417Medicare UPIN
ILF400160793Medicare PIN
IL202845118Medicare PIN
WI000180070Medicare PIN