Provider Demographics
NPI:1043379431
Name:VAIL, KATHLEEN M (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:VAIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10909 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3227
Mailing Address - Country:US
Mailing Address - Phone:773-779-7970
Mailing Address - Fax:773-779-7969
Practice Address - Street 1:10909 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3227
Practice Address - Country:US
Practice Address - Phone:773-779-7970
Practice Address - Fax:773-779-7969
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25653Medicare PIN