Provider Demographics
NPI:1376628883
Name:BLACKWELL, KAREN LYNN (PT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:KLECKA
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, PCS
Mailing Address - Street 1:1760 MARION CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3319
Mailing Address - Country:US
Mailing Address - Phone:630-653-0659
Mailing Address - Fax:
Practice Address - Street 1:309 W NEW INDIAN TR AIL CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-966-4000
Practice Address - Fax:630-906-9858
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics