Provider Demographics
NPI:1336468966
Name:KATHALYNAS SPINE, SPORT & REHABILITATION LLC
Entity Type:Organization
Organization Name:KATHALYNAS SPINE, SPORT & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:KATHALYNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-932-2137
Mailing Address - Street 1:206 E CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-2239
Mailing Address - Country:US
Mailing Address - Phone:618-435-9393
Mailing Address - Fax:618-937-3500
Practice Address - Street 1:206 E CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-2239
Practice Address - Country:US
Practice Address - Phone:618-435-9393
Practice Address - Fax:618-937-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty