Provider Demographics
NPI:1548588593
Name:DANIELS, KATHRYN LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LOUISE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LOUISE
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4111 N ILLINOIS ST
Mailing Address - Street 2:STE C
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7609
Mailing Address - Country:US
Mailing Address - Phone:618-235-0700
Mailing Address - Fax:618-235-0717
Practice Address - Street 1:4111 N ILLINOIS ST
Practice Address - Street 2:STE C
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-7609
Practice Address - Country:US
Practice Address - Phone:618-235-0700
Practice Address - Fax:618-235-0717
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist