Provider Demographics
NPI:1477111235
Name:DALE, KAITLYN YVONNE KLUGE (PT,DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:YVONNE KLUGE
Last Name:DALE
Suffix:
Gender:
Credentials:PT,DPT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:YVONNE
Other - Last Name:KLUGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:148 FOOTHILLS CENTER DR STE 148&150
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2518
Practice Address - Country:US
Practice Address - Phone:864-638-6405
Practice Address - Fax:864-638-6421
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist