Provider Demographics
NPI:1700159688
Name:BURDICK, KATE CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:CHRISTINE
Last Name:BURDICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-0228
Mailing Address - Country:US
Mailing Address - Phone:312-642-3963
Mailing Address - Fax:312-642-3966
Practice Address - Street 1:100 E WALTON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1448
Practice Address - Country:US
Practice Address - Phone:312-642-3963
Practice Address - Fax:312-642-3966
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist