Provider Demographics
NPI:1366044232
Name:PYTEL, KALEB JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:JAMES
Last Name:PYTEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 TONTI ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-1641
Mailing Address - Country:US
Mailing Address - Phone:815-830-0999
Mailing Address - Fax:
Practice Address - Street 1:310 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1946
Practice Address - Country:US
Practice Address - Phone:815-780-3509
Practice Address - Fax:815-224-6744
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist