Provider Demographics
NPI:1740390095
Name:RYAN CEISEL, KATHLEEN A (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:RYAN CEISEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1541 SOUTHRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6602
Mailing Address - Country:US
Mailing Address - Phone:847-987-0438
Mailing Address - Fax:
Practice Address - Street 1:1213 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2741
Practice Address - Country:US
Practice Address - Phone:224-505-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700071822081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568080OtherMEDICARE GROUP NUMBER
ILDC7571OtherR.R. GROUP #
IL1623066OtherBCBS PROVIDER #
IL367885100OtherU S DEPT OF LABOR PROV#
IL567700OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
ILP00304982OtherR.R. MEDICARE PIN #
ILK51713Medicare PIN
IL568080OtherMEDICARE GROUP NUMBER
ILK51714Medicare PIN
IL1619908OtherBCBS IL GROUP NUMBER
ILP00304982OtherR.R. MEDICARE PIN #