Provider Demographics
NPI:1851456263
Name:COTTONE, KRISTINE L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:COTTONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:L
Other - Last Name:DALGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2200 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-661-6260
Mailing Address - Fax:309-862-4754
Practice Address - Street 1:2200 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-661-6260
Practice Address - Fax:309-862-4754
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03989OtherIOWA PT LICENSE NUMBER
IL070.014913OtherIL LICENSE
IL070.014913OtherIL LICENSE