Provider Demographics
NPI:1497005235
Name:HUGHES, KERRY MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MICHELLE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALIFORNIA AVENUE AT 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1797
Mailing Address - Country:US
Mailing Address - Phone:773-257-5628
Mailing Address - Fax:773-257-6327
Practice Address - Street 1:CALIFORNIA AVENUE AT 15TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1797
Practice Address - Country:US
Practice Address - Phone:773-257-5628
Practice Address - Fax:773-257-6327
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist