Provider Demographics
NPI:1790988749
Name:KADOW-LEVAR, JOAN (PT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:KADOW-LEVAR
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 1:8120 W GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1542
Mailing Address - Country:US
Mailing Address - Phone:773-774-0978
Mailing Address - Fax:
Practice Address - Street 1:8120 W GREGORY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1542
Practice Address - Country:US
Practice Address - Phone:773-774-0978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.004959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.004959OtherPHYSICAL THERAPIST LICENS