Provider Demographics
NPI:1891319968
Name:JUDE, KENNETH (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:JUDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:JUDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1622 PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2683
Mailing Address - Country:US
Mailing Address - Phone:630-681-1760
Mailing Address - Fax:
Practice Address - Street 1:9760 SORENG AVE
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-2105
Practice Address - Country:US
Practice Address - Phone:847-671-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist