Provider Demographics
NPI:1558300129
Name:KEEFNER, CORISSA JEAN (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CORISSA
Middle Name:JEAN
Last Name:KEEFNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 N KENMORE AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2092
Mailing Address - Country:US
Mailing Address - Phone:773-458-3835
Mailing Address - Fax:
Practice Address - Street 1:4007 N KENMORE AVE
Practice Address - Street 2:APT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2092
Practice Address - Country:US
Practice Address - Phone:773-458-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist