Provider Demographics
NPI:1508975541
Name:HRUSKA, KIMBERLY ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSE
Last Name:HRUSKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ZACHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:326 N. MICHIGAN AVE
Practice Address - Street 2:2ND LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3714
Practice Address - Country:US
Practice Address - Phone:312-229-5271
Practice Address - Fax:312-578-0795
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22493Medicare ID - Type UnspecifiedKENDALL COUNTY
ILK53176Medicare PIN
ILK22495Medicare ID - Type UnspecifiedCOOK COUNTY
ILK22494Medicare ID - Type Unspecified
ILK53177Medicare PIN
ILK47337Medicare PIN