Healthcare Provider Details

I. General information

NPI: 1861475220
Provider Name (Legal Business Name): THERESA M BARON PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA M HELNING

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 MAPLE AVE
LISLE IL
60532-3280
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 630-326-8810
  • Fax: 630-326-8813
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4433-024
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number62-039
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-016793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: