Provider Demographics
NPI:1518104512
Name:VAN HAM, KRISTI A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:VAN HAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:A
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:732 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013
Practice Address - Country:US
Practice Address - Phone:847-462-0780
Practice Address - Fax:847-462-0755
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6697013OtherMEDICARE
ILIL6238015OtherMEDICARE
ILIL6237015OtherMEDICARE
ILIL6238015OtherMEDICARE
IL0604410001Medicare NSC
ILIL6697013OtherMEDICARE