Provider Demographics
NPI:1134293129
Name:KLEINMAN, SHELLEY (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6407
Mailing Address - Country:US
Mailing Address - Phone:847-498-1490
Mailing Address - Fax:847-498-1494
Practice Address - Street 1:3105 FLORAL DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6407
Practice Address - Country:US
Practice Address - Phone:847-498-1490
Practice Address - Fax:847-498-1494
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636125OtherBCBS NUMBER