Provider Demographics
NPI:1720488539
Name:PASQUINELLI, KAITLYN M (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:PASQUINELLI
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1570
Mailing Address - Country:US
Mailing Address - Phone:847-267-8600
Mailing Address - Fax:847-267-9520
Practice Address - Street 1:2211 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1570
Practice Address - Country:US
Practice Address - Phone:847-267-8600
Practice Address - Fax:847-267-9520
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist