Provider Demographics
NPI:1952847972
Name:HERMANAS, KATHRYN SUZANNE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUZANNE
Last Name:HERMANAS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 S. 69TH COURT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1638
Mailing Address - Country:US
Mailing Address - Phone:708-691-7458
Mailing Address - Fax:
Practice Address - Street 1:12213 S 69TH CT
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1638
Practice Address - Country:US
Practice Address - Phone:708-691-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0042922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer