Provider Demographics
NPI:1356035869
Name:KREISER, ANN MARIE (DPT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KREISER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:425 N LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1647
Mailing Address - Country:US
Mailing Address - Phone:815-228-8546
Mailing Address - Fax:
Practice Address - Street 1:6501 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2932
Practice Address - Country:US
Practice Address - Phone:309-621-4111
Practice Address - Fax:309-621-4119
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist