Provider Demographics
NPI:1457603698
Name:KNIPPING, JONATHAN Y (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:Y
Last Name:KNIPPING
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 1:7620 N OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3127
Mailing Address - Country:US
Mailing Address - Phone:773-934-4216
Mailing Address - Fax:
Practice Address - Street 1:640 BUSSE HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2502
Practice Address - Country:US
Practice Address - Phone:773-934-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.019287OtherSTATE LICENSE