Provider Demographics
NPI:1639371776
Name:KAHN, KRISTINE S (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:S
Last Name:KAHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:S
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1294 S ROUTE 12
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1950
Practice Address - Country:US
Practice Address - Phone:847-973-9440
Practice Address - Fax:847-973-9442
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist