Provider Demographics
NPI:1972952786
Name:KOCKLER, KIRSTEN L (DPT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:KOCKLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:L
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:720 W US HIGHWAY 18 STE B
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1022
Practice Address - Country:US
Practice Address - Phone:641-924-0205
Practice Address - Fax:641-924-0207
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083101225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty