MEDICARE: KENDRA ERVEN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070008143	IL

General Provider Information

NPI Number	:	1710902713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA ERVEN P.T.

Provider Business Mailing Address
First Line	:	245 S GARY AVE
Second Line	:	SUITE 101
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2228
Country	:	US
Telephone Number	:	630-315-8710
Fax Number	:	630-315-8725

Provider Business Practice Location Address
First Line	:	245 S GARY AVE
Second Line	:	SUITE 101
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2228
Country	:	US
Telephone Number	:	630-315-8710
Fax Number	:	630-315-8725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/28/2016

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