Provider Demographics
NPI:1134797442
Name:WENTWORTH, CONOR (DPT)
Entity type:Individual
Prefix:DR
First Name:CONOR
Middle Name:
Last Name:WENTWORTH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:3620 CONCORD PIKE SPC L
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5022
Practice Address - Country:US
Practice Address - Phone:302-281-3072
Practice Address - Fax:302-268-9081
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02006900225100000X
PAPT031754225100000X
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist