Provider Demographics
NPI:1083196307
Name:KESTER, SHAWNA E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:E
Last Name:KESTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:E
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1252
Mailing Address - Country:US
Mailing Address - Phone:815-632-5285
Mailing Address - Fax:815-632-5824
Practice Address - Street 1:1809 LOCUST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1101
Practice Address - Country:US
Practice Address - Phone:815-632-5285
Practice Address - Fax:815-632-5824
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist