Provider Demographics
NPI:1205154671
Name:EVERETT, ERIN A (DPT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:A
Last Name:EVERETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:FARNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8863
Mailing Address - Country:US
Mailing Address - Phone:641-223-0462
Mailing Address - Fax:
Practice Address - Street 1:11411 W 183RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9450
Practice Address - Country:US
Practice Address - Phone:708-478-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist