Provider Demographics
NPI:1043299241
Name:KOERBER, CAMILLA RAE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:RAE
Last Name:KOERBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:CAMILLA
Other - Middle Name:RAE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:6413 DUTCHMANS PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3339
Practice Address - Country:US
Practice Address - Phone:502-694-3500
Practice Address - Fax:502-537-6377
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77458Medicare ID - Type UnspecifiedPROVIDER NUMBER