Provider Demographics
NPI:1114071081
Name:CARLSTEDT, KRISTEN E (MS, PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:CARLSTEDT
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 JOHNSON DR
Mailing Address - Street 2:APT 1412
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6971
Mailing Address - Country:US
Mailing Address - Phone:414-467-4198
Mailing Address - Fax:
Practice Address - Street 1:755 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2805
Practice Address - Country:US
Practice Address - Phone:847-272-7426
Practice Address - Fax:847-412-6440
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist