Provider Demographics
NPI:1558697300
Name:NEWHOUSE, KATHLEEN MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13524 JULIE DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-7829
Mailing Address - Country:US
Mailing Address - Phone:815-765-1155
Mailing Address - Fax:815-765-1166
Practice Address - Street 1:13524 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-7829
Practice Address - Country:US
Practice Address - Phone:815-765-1155
Practice Address - Fax:815-765-1166
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3551002Medicare PIN