Provider Demographics
NPI:1992856462
Name:VIETTI, KERI GILLMORE (PT, MS)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:GILLMORE
Last Name:VIETTI
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 N KEDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3511
Mailing Address - Country:US
Mailing Address - Phone:773-203-5408
Mailing Address - Fax:773-305-7730
Practice Address - Street 1:6725 N KEDVALE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3511
Practice Address - Country:US
Practice Address - Phone:773-203-5408
Practice Address - Fax:773-305-7730
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist