Provider Demographics
NPI:1942375530
Name:HALVADIA, KETKI (LPT)
Entity Type:Individual
Prefix:
First Name:KETKI
Middle Name:
Last Name:HALVADIA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:STE. #206
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-516-8187
Practice Address - Fax:847-516-8235
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPO0197554Medicare ID - Type UnspecifiedRAIL ROAD MCARE LOC16
ILK15980Medicare ID - Type UnspecifiedMCARE LOC16