Healthcare Provider Details

I. General information

NPI: 1548302235
Provider Name (Legal Business Name): TERRANCE RONALD WALTER RRT, CPFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BANGS ST
AURORA IL
60505-5311
US

IV. Provider business mailing address

701 BANGS ST
AURORA IL
60505-5311
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2235
Mailing address:
  • Phone: 630-898-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: