Active NPI
Julie Sudduth Koesterer, PT
- Physical Therapist
- Shiloh, IL
National Provider Identifier
1114036761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 1901 Frank Scott Pkwy E
Shiloh, IL 62269-7296 - Phone
- (618) 624-7077
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
1901 Frank Scott Pkwy E
Shiloh, IL 62269-7296
Mailing address
105 Eden Park Blvd
Shiloh, IL 62269-2999
Phone (618) 624-0960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070-006771 | Other | IL | LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284595200000",
"number": "1114036761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 EDEN PARK BLVD",
"city": "SHILOH",
"state": "IL",
"postal_code": "622692999",
"telephone_number": "618-624-0960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 FRANK SCOTT PKWY E",
"city": "SHILOH",
"state": "IL",
"postal_code": "622697296",
"telephone_number": "618-624-7077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOESTERER",
"first_name": "JULIE",
"middle_name": "SUDDUTH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2010-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "070-006771",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shiloh, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.