Provider Demographics
NPI:1780916759
Name:BUDDELL, KATHLEEN LOUISE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:BUDDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 WAUKEGAN RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5514
Mailing Address - Country:US
Mailing Address - Phone:847-405-7611
Mailing Address - Fax:847-405-7622
Practice Address - Street 1:2525 WAUKEGAN RD
Practice Address - Street 2:SUITE 255
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-5514
Practice Address - Country:US
Practice Address - Phone:847-405-7611
Practice Address - Fax:847-405-7622
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist