Basic Information
| Provider Information | |||||||||
| NPI: | 1285189043 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THOMAS | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 W MADISON ST APT 3204 | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606612423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597609233 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 WAUKEGAN RD STE B | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600255154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477076744 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2016 | ||||||||
| LastUpdateDate: | 08/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070.022549 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.