Provider Demographics
NPI:1134629777
Name:MCDERMOTT, ERIN MAUREEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MAUREEN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MAUREEN
Other - Last Name:GAFFNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1517 S BATES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3347
Mailing Address - Country:US
Mailing Address - Phone:216-973-7468
Mailing Address - Fax:
Practice Address - Street 1:455 BUTLER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3013
Practice Address - Country:US
Practice Address - Phone:216-973-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023522225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1134629777OtherBLUE CROSS BLUE SHIELD