Provider Demographics
NPI:1518982263
Name:MORETTI, KRISTIN JUNE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JUNE
Last Name:MORETTI
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 1:1400 N NORTHWEST HIGHWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-297-7020
Mailing Address - Fax:847-297-7022
Practice Address - Street 1:1400 N NORTHWEST HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-297-7020
Practice Address - Fax:847-297-7022
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
L39147Medicare UPIN
374610Medicare ID - Type Unspecified