Provider Demographics
NPI:1174650550
Name:VERBEEREN-BANTING, TERRI LEE (MPT)
Entity type:Individual
Prefix:
First Name:TERRI LEE
Middle Name:
Last Name:VERBEEREN-BANTING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TERRI LEE
Other - Middle Name:
Other - Last Name:VERBEEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:183 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1243
Practice Address - Country:US
Practice Address - Phone:815-261-0044
Practice Address - Fax:815-513-9397
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00380Medicare PIN
ILR00379Medicare PIN
IL213003Medicare PIN