Provider Demographics
NPI:1215383146
Name:BLANKSHAIN, KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BLANKSHAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 TUDOR LN UNIT 306
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3780
Mailing Address - Country:US
Mailing Address - Phone:847-452-4066
Mailing Address - Fax:
Practice Address - Street 1:1781 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3532
Practice Address - Country:US
Practice Address - Phone:847-452-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist