Individual
HERBERT DEITERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
15750 MARIAN DR, HOMER GLEN, IL 60491-6200
(708) 645-3400
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070015746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS OF IL
IL
01
—
1623066
BCBS PROVIDER #
IL
01
—
367885100
US DEPT OF LABOR
IL
Enumeration date
05/24/2007
Last updated
09/14/2012
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