Basic Information
| Provider Information | |||||||||
| NPI: | 1790735165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOX | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6013 | ||||||||
| Address2: | |||||||||
| City: | ST CHARLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601746013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304669240 | ||||||||
| FaxNumber: | 6302622643 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 KESLINGER RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601344645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302622633 | ||||||||
| FaxNumber: | 6302622643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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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 | 208100000X | 070007933 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.