Provider Demographics
NPI:1851492912
Name:KETT, MIKE (MS, PT)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:KETT
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:533 W NORTH AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2135
Mailing Address - Country:US
Mailing Address - Phone:630-832-6919
Mailing Address - Fax:630-832-6928
Practice Address - Street 1:3540 SEVEN BRIDGES DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1221
Practice Address - Country:US
Practice Address - Phone:630-968-3154
Practice Address - Fax:630-968-3224
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist