Provider Demographics
NPI:1578735916
Name:THOMANN, KELLY ELAINE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELAINE
Last Name:THOMANN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:KEPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1301 W EVERGREEN AVE STE 1A
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1634
Practice Address - Country:US
Practice Address - Phone:217-690-4882
Practice Address - Fax:217-690-4883
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist