Provider Demographics
NPI:1831391234
Name:KLEBER, DOUGLAS GEORGE
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:KLEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1127
Mailing Address - Country:US
Mailing Address - Phone:217-337-0074
Mailing Address - Fax:217-337-1914
Practice Address - Street 1:1804 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1023
Practice Address - Country:US
Practice Address - Phone:217-337-4313
Practice Address - Fax:217-337-1914
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1290226300000X
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist