Active NPI
Emily Kocanda, PT, DPT, LMT
- Physical Therapist
- Lake Bluff, IL
National Provider Identifier
1114693660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070023032
- Practice address
- 611 Rockland Rd Ste 105
Lake Bluff, IL 60044-2000 - Phone
- (847) 234-4847
- Fax
- (847) 234-4850
- NPI assigned
- Aug 16, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227013152 | IL | |
| Physical Therapist | 225100000X | 070023032 | IL | Primary |
Addresses
Primary practice location
611 Rockland Rd Ste 105
Lake Bluff, IL 60044-2000
Mailing address
611 Rockland Rd Ste 102
Lake Bluff, IL 60044-2000
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | http://www.fitforlifeclinic.com | ||
| Other URL | http://www.fitforlifeclinic.com |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070023032 | IL | MD | Physical Therapist |
| 227013152 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629072000000",
"number": "1114693660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 ROCKLAND RD STE 102",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "600442000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 ROCKLAND RD STE 105",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "600442000",
"telephone_number": "847-234-4847",
"fax_number": "847-234-4850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCANDA",
"first_name": "EMILY",
"name_prefix": "Dr.",
"credential": "PT, DPT, LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-16",
"last_updated": "2021-08-16",
"certification_date": "2021-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227013152",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070023032",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "http://www.fitforlifeclinic.com",
"affiliation": "N",
"address_1": "611 Rockland Rd Ste 105",
"city": "Lake Bluff",
"state": "IL",
"country_code": "US",
"postal_code": "600442000",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "http://www.fitforlifeclinic.com",
"affiliation": "N",
"address_1": "611 Rockland Rd Ste 105",
"city": "Lake Bluff",
"state": "IL",
"country_code": "US",
"postal_code": "600442000",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lake Bluff, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.