Provider Demographics
NPI:1225572530
Name:LONDON, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E MAIN ST
Mailing Address - Street 2:STE 405
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2205
Mailing Address - Country:US
Mailing Address - Phone:630-492-1348
Mailing Address - Fax:
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:STE 405
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:630-492-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.018669172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist