Provider Demographics
NPI:1366554925
Name:BARUTH, TAMMY LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:BARUTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:LEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
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:
Practice Address - Street 1:732 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2078
Practice Address - Country:US
Practice Address - Phone:847-462-0780
Practice Address - Fax:847-462-0755
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6697003OtherMEDICARE
IL0604410001OtherDMERC
ILIL6237005OtherMEDICARE
ILIL6238005OtherMEDICARE
ILP01060239OtherRAILROAD MEDICARE
ILIL6238005OtherMEDICARE
ILK16719Medicare ID - Type Unspecified