Provider Demographics
NPI:1932405248
Name:BERONIO, FAITH (PT)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BERONIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 PACIFIC AVE APT F
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4734
Mailing Address - Country:US
Mailing Address - Phone:773-306-9397
Mailing Address - Fax:
Practice Address - Street 1:10700 W HIGGINS RD STE 120
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3714
Practice Address - Country:US
Practice Address - Phone:847-299-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016842225100000X
MO2006028878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist