Provider Demographics
NPI:1689686008
Name:RICHARD, KRISTEN (PT, OCS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MARKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:337 W. OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559
Mailing Address - Country:US
Mailing Address - Phone:630-323-8646
Mailing Address - Fax:630-323-8656
Practice Address - Street 1:13500 CIRCLE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1339
Practice Address - Country:US
Practice Address - Phone:708-403-8145
Practice Address - Fax:708-403-8147
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist