Active NPI
Therese R Southworth, PT
- Physical Therapist
- Wheaton, IL
National Provider Identifier
1356394068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-004371
- Practice address
- 1925 N Gary Ave
Wheaton, IL 60187-3056 - Phone
- (630) 653-6336
- Fax
- (630) 653-6446
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-004371 | IL | Primary |
Addresses
Primary practice location
1925 N Gary Ave
Wheaton, IL 60187-3056
Mailing address
205 W Wacker Dr
Suite105
Chicago, IL 60606-1216
Phone (312) 640-0329
Other names 1
- Therese R Brehmer
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-004371 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oad Orthopaedics, LTD | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393804800000",
"number": "1356394068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 W WACKER DR",
"address_2": "SUITE105",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606061216",
"telephone_number": "312-640-0329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 N GARY AVE",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873056",
"telephone_number": "630-653-6336",
"fax_number": "630-653-6446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHWORTH",
"first_name": "THERESE",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2014-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-004371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "THERESE",
"last_name": "BREHMER",
"middle_name": "R",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.