Provider Demographics
NPI:1780809608
Name:SKARE, KRISTINA RANAE (PT, MPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RANAE
Last Name:SKARE
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N WOOD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2017
Mailing Address - Country:US
Mailing Address - Phone:773-988-5617
Mailing Address - Fax:
Practice Address - Street 1:7411 LAKE ST STE 2190
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1897
Practice Address - Country:US
Practice Address - Phone:708-488-1700
Practice Address - Fax:708-488-2391
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist