=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336347327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOREN M GINERIS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40W145 FABYAN PARKWAY
-----------------------------------------------------
City | ELBURN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-365-5550
-----------------------------------------------------
Fax | 630-365-6777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 373 40W396 TAYLOR CALDWELL STREET
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-715-0354
-----------------------------------------------------
Fax | 630-584-8895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070011384
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------