Provider Demographics
NPI:1689721920
Name:NOLAN, KATHLEEN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:101 UNIVERSITY DR
Practice Address - Street 2:SUITE A-6
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2473
Practice Address - Country:US
Practice Address - Phone:413-366-5703
Practice Address - Fax:413-992-2019
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19401225100000X
NY016626-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic