Provider Demographics
NPI:1174635130
Name:SCHMITT, KIMBERLY M (MPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:2674 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4917
Practice Address - Country:US
Practice Address - Phone:847-336-8089
Practice Address - Fax:847-336-8079
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6697012OtherMEDICARE
ILP00377599OtherRAILROAD MEDICARE NUMBER
ILK29673OtherMEDICARE NUMBER
ILK38400OtherMEDICARE NUMBER
ILIL6237002OtherMEDICARE
ILIL6238002OtherMEDICARE