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NPI Code Detail

MEDICARE: TERRANCE BRENDAN

MEDICARE: TERRANCE BRENDAN
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
1208100000XPhysical Medicine & Rehabilitation PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101633096OTHERILBCBS

General Provider Information

NPI Number : 1891789145
Entity Type Code : Organization
Provider Name (Legal Business Name) : TERRANCE BRENDAN
Provider Business Mailing Address
First Line : 985 S BUFFALO GROVE RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-3702
Country : US
Telephone Number : 847-541-4878
Fax Number : 847-520-0500
Provider Business Practice Location Address
First Line : 985 S BUFFALO GROVE RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-3702
Country : US
Telephone Number : 847-541-4878
Fax Number : 847-520-0500
Authorized Official
Title or Position : OWNER/PHYSICAL THERAPIST
Name : MR. TERRANCE BRENDAN SHEA
Credential : PT
Telephone Number : 847-541-4878
Provider Enumeration Date : 09/01/2005
Last Update Date : 08/22/2020

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Directions to “TERRANCE BRENDAN ” Practice Location

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