Provider Demographics
NPI:1790824993
Name:KIRCHGESSNER, SUSAN (PT,L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KIRCHGESSNER
Suffix:
Gender:F
Credentials:PT,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 N PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1883
Mailing Address - Country:US
Mailing Address - Phone:309-337-3547
Mailing Address - Fax:
Practice Address - Street 1:1369 N PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1883
Practice Address - Country:US
Practice Address - Phone:309-337-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics