Provider Demographics
NPI:1669514402
Name:KITTEL, JODI (MPT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:KITTEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:106 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-4736
Practice Address - Country:US
Practice Address - Phone:414-831-0660
Practice Address - Fax:414-967-4736
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011279225100000X
WI12947-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF400186413Medicare PIN
IL212623004Medicare PIN
IL202845042Medicare PIN
IL212989006Medicare PIN
IL212622004Medicare PIN
IL214708007Medicare PIN