Provider Demographics
NPI:1548302235
Name:WALTER, TERRANCE RONALD (RRT, CPFT)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:RONALD
Last Name:WALTER
Suffix:
Gender:M
Credentials:RRT, CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BANGS ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-5311
Mailing Address - Country:US
Mailing Address - Phone:630-898-5069
Mailing Address - Fax:
Practice Address - Street 1:701 BANGS ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-5311
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILVAD000Medicare UPIN