Provider Demographics
NPI:1487043188
Name:MESTEK, KAREN ANN BURNETT (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN BURNETT
Last Name:MESTEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:680 N LAKE SHORE DR STE 830
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8702
Mailing Address - Country:US
Mailing Address - Phone:312-926-8811
Mailing Address - Fax:312-926-8815
Practice Address - Street 1:680 N LAKE SHORE DR STE 830
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8702
Practice Address - Country:US
Practice Address - Phone:312-926-8811
Practice Address - Fax:312-926-8815
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400189528Medicare PIN