Provider Demographics
NPI:1184742207
Name:FREEMAN, KANE M (PT)
Entity type:Individual
Prefix:MR
First Name:KANE
Middle Name:M
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249
Mailing Address - Country:US
Mailing Address - Phone:618-654-4701
Mailing Address - Fax:618-654-4739
Practice Address - Street 1:67 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249
Practice Address - Country:US
Practice Address - Phone:618-654-4701
Practice Address - Fax:618-654-4739
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009706225100000X
IL07009706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist