Provider Demographics
NPI:1679528590
Name:WILLIAMS, KRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:
Practice Address - Street 1:6540 N LINCOLN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3933
Practice Address - Country:US
Practice Address - Phone:847-779-7900
Practice Address - Fax:847-779-7901
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31830Medicare PIN
ILK31831Medicare PIN