Provider Demographics
NPI:1891789145
Name:TERRANCE BRENDAN
Entity Type:Organization
Organization Name:TERRANCE BRENDAN
Other - Org Name:SHEA PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:BRENDAN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-541-4878
Mailing Address - Street 1:985 S BUFFALO GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3702
Mailing Address - Country:US
Mailing Address - Phone:847-541-4878
Mailing Address - Fax:847-520-0500
Practice Address - Street 1:985 S BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3702
Practice Address - Country:US
Practice Address - Phone:847-541-4878
Practice Address - Fax:847-520-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633096OtherBCBS
205045Medicare ID - Type Unspecified
S84111Medicare UPIN