Provider Demographics
NPI:1811905680
Name:TEBRY, ASHRAF (PT)
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:TEBRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1643
Mailing Address - Country:US
Mailing Address - Phone:773-284-0888
Mailing Address - Fax:773-284-0880
Practice Address - Street 1:5764 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1643
Practice Address - Country:US
Practice Address - Phone:773-284-0888
Practice Address - Fax:773-284-0880
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207513Medicare ID - Type Unspecified