Provider Demographics
NPI:1396916318
Name:KIRKPATRICK, PEGGY (PT)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S FRONTAGE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5830
Mailing Address - Country:US
Mailing Address - Phone:847-680-3020
Mailing Address - Fax:847-680-3077
Practice Address - Street 1:1850 W WINCHESTER RD
Practice Address - Street 2:SUITE 223
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5357
Practice Address - Country:US
Practice Address - Phone:847-680-3020
Practice Address - Fax:847-680-3077
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00565Medicare PIN