Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | IL |
NPI | 1114126794 |
---|---|
Provider Name | Mr. Kerwin M Yenter |
First Address | Downers Grove, IL 60515-3202 |
Second Address | Orland Park, IL 60467-5441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |