Provider Demographics
NPI:1558791939
Name:RYAN, MARY KATE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATE
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:KATE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:773-256-5799
Mailing Address - Fax:773-363-3481
Practice Address - Street 1:6501 S PROMONTORY DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1003
Practice Address - Country:US
Practice Address - Phone:773-256-5799
Practice Address - Fax:773-363-3481
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700204092251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics