Provider Demographics
NPI:1689023053
Name:SMITH, KATHLEEN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:UHLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:3141 S MCCLINTOCK DR STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5682
Practice Address - Country:US
Practice Address - Phone:480-566-8125
Practice Address - Fax:480-566-8126
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30919225100000X
MO2016021900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist