Provider Demographics
NPI:1801863519
Name:KLEINE, BRAD EDWARD (ATC, NASM-PES)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:EDWARD
Last Name:KLEINE
Suffix:
Gender:M
Credentials:ATC, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 RED TOP LN
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8213
Mailing Address - Country:US
Mailing Address - Phone:708-670-3520
Mailing Address - Fax:
Practice Address - Street 1:17837 80TH AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-5023
Practice Address - Country:US
Practice Address - Phone:708-342-2500
Practice Address - Fax:708-342-1454
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer