Healthcare Provider Details

I. General information

NPI: 1891789145
Provider Name (Legal Business Name): TERRANCE BRENDAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 S BUFFALO GROVE RD
BUFFALO GROVE IL
60089-3702
US

IV. Provider business mailing address

985 S BUFFALO GROVE RD
BUFFALO GROVE IL
60089-3702
US

V. Phone/Fax

Practice location:
  • Phone: 847-541-4878
  • Fax: 847-520-0500
Mailing address:
  • Phone: 847-541-4878
  • Fax: 847-520-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. TERRANCE BRENDAN SHEA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 847-541-4878