Provider Demographics
NPI:1437274677
Name:KINNEY, JACQUELINE (PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 LEOMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-2831
Mailing Address - Country:US
Mailing Address - Phone:815-741-1690
Mailing Address - Fax:
Practice Address - Street 1:421 DORIS AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2569
Practice Address - Country:US
Practice Address - Phone:815-740-8986
Practice Address - Fax:815-774-9152
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant