Provider Demographics
NPI:1619148673
Name:HOYT, KELLEY C (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:C
Last Name:HOYT
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2315
Mailing Address - Country:US
Mailing Address - Phone:708-670-4216
Mailing Address - Fax:224-333-5747
Practice Address - Street 1:269 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8032
Practice Address - Country:US
Practice Address - Phone:815-893-0439
Practice Address - Fax:844-859-5959
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2483Medicare UPIN