Provider Demographics
NPI:1790735165
Name:KNOX, KELLIE L (PT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:KNOX
Suffix:
Gender:F
Credentials:PT
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 6013
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-6013
Mailing Address - Country:US
Mailing Address - Phone:630-466-9240
Mailing Address - Fax:630-262-2643
Practice Address - Street 1:2700 KESLINGER RD
Practice Address - Street 2:SUITE C
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:630-262-2633
Practice Address - Fax:630-262-2643
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation