Provider Demographics
NPI:1295793115
Name:TRANSUE, KIRSTEN (LPT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:TRANSUE
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 1:2201 W WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6498
Mailing Address - Country:US
Mailing Address - Phone:217-546-3301
Mailing Address - Fax:217-546-3302
Practice Address - Street 1:2201 W WHITE OAKS DR STE B-2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6498
Practice Address - Country:US
Practice Address - Phone:217-416-7712
Practice Address - Fax:217-546-3302
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8189225100000X
IL070.016127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211154Medicaid
NC2503801FMedicare ID - Type Unspecified