Provider Demographics
NPI:1205366283
Name:KAHLE, KELLEIGH
Entity Type:Individual
Prefix:
First Name:KELLEIGH
Middle Name:
Last Name:KAHLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLEIGH
Other - Middle Name:
Other - Last Name:MCCREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9020 SCHAFER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8970
Mailing Address - Country:US
Mailing Address - Phone:219-308-9980
Mailing Address - Fax:
Practice Address - Street 1:355 E ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3167
Practice Address - Country:US
Practice Address - Phone:312-238-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist