Provider Demographics
NPI:1841380664
Name:KENNY, KRISTIN M (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:KENNY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:HOSEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-327-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:350 S GREENLEAF ST STE 403
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5709
Practice Address - Country:US
Practice Address - Phone:847-596-7640
Practice Address - Fax:847-596-7641
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ8115OtherR.R. MEDICARE GRP #
IL568080OtherMEDICARE GROUP NUMBER
IL367885100OtherUS DEPT LABOR PROV #
IL1623066OtherBCBS PROVIDER #
IL1619908OtherBCBS IL GROUP NUMBER
ILK51850Medicare PIN
IL567770Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL367885100OtherUS DEPT LABOR PROV #
ILK21594Medicare PIN
ILCJ8115OtherR.R. MEDICARE GRP #
IL200852Medicare ID - Type UnspecifiedMEDICARE GRP #
ILK21595Medicare PIN
IL1623066OtherBCBS PROVIDER #