Provider Demographics
NPI:1114126794
Name:YENTER, KERWIN M (PT)
Entity type:Individual
Prefix:MR
First Name:KERWIN
Middle Name:M
Last Name:YENTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3202
Mailing Address - Country:US
Mailing Address - Phone:312-909-9525
Mailing Address - Fax:
Practice Address - Street 1:16450 104TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5441
Practice Address - Country:US
Practice Address - Phone:708-364-8441
Practice Address - Fax:708-364-8443
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
IL0700134892251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11544Medicare PIN