Provider Demographics
NPI:1336347327
Name:GINERIS, LOREN M (PT)
Entity type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:M
Last Name:GINERIS
Suffix:
Gender:
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:PO BOX 373
Mailing Address - Street 2:40W396 TAYLOR CALDWELL STREET
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-715-0354
Mailing Address - Fax:630-584-8895
Practice Address - Street 1:40W145 FABYAN PARKWAY
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119
Practice Address - Country:US
Practice Address - Phone:630-365-5550
Practice Address - Fax:630-365-6777
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist