Provider Demographics
NPI:1902946940
Name:MCINERNEY, CARA (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:9645 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1722
Practice Address - Country:US
Practice Address - Phone:773-239-2734
Practice Address - Fax:773-239-2784
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00943123OtherMEDICARE RAILROAD
IL211585002Medicare PIN
IL216859080Medicare PIN
IL202845097Medicare PIN