Provider Demographics
NPI:1700041936
Name:KLATT, LYNN M (LPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KLATT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72180
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-0180
Mailing Address - Country:US
Mailing Address - Phone:630-924-0156
Mailing Address - Fax:630-924-0462
Practice Address - Street 1:501 N RIVERSIDE DR
Practice Address - Street 2:STE. #213
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5918
Practice Address - Country:US
Practice Address - Phone:847-625-9500
Practice Address - Fax:847-625-9595
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02970Medicare PIN