Provider Demographics
NPI:1013385905
Name:CEISEL, KATHERINE M (PT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:CEISEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 S LINCOLN ST
Mailing Address - Street 2:STE 6
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2704
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:852 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1853
Practice Address - Country:US
Practice Address - Phone:847-441-5788
Practice Address - Fax:847-784-8720
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist