Provider Demographics
NPI:1093173759
Name:ROMMELFANGER, KELLSEY L (DPT)
Entity Type:Individual
Prefix:
First Name:KELLSEY
Middle Name:L
Last Name:ROMMELFANGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLSEY
Other - Middle Name:L
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:695 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6531
Practice Address - Country:US
Practice Address - Phone:630-368-1776
Practice Address - Fax:773-967-1112
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13278225100000X
IL070.027696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist