Provider Demographics
NPI:1689847451
Name:SCHAEFER, KATHY C (LPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:C
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:C
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-0326
Mailing Address - Country:US
Mailing Address - Phone:618-585-4761
Mailing Address - Fax:618-585-3523
Practice Address - Street 1:128 NORTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014
Practice Address - Country:US
Practice Address - Phone:618-585-4761
Practice Address - Fax:618-585-3523
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL910882OtherHEALTHLINK
IL5932026OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL9465114OtherAETNA
IL2602740OtherUNITED HEALTHCARE
IL708779OtherACN
ILP00614251Medicare PIN
IL5932026OtherBLUE CROSS BLUE SHIELD OF ILLINOIS