Provider Demographics
NPI:1053475103
Name:ORR, KENNETH MICHAEL JR (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:ORR
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:2514 BURR OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2027
Mailing Address - Country:US
Mailing Address - Phone:708-715-2335
Mailing Address - Fax:708-229-0090
Practice Address - Street 1:9618 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2862
Practice Address - Country:US
Practice Address - Phone:708-229-0101
Practice Address - Fax:708-229-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist