Kristy L Illg, PT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT28806 Issued in CA

Practice address

UC Berkeley Athletics - 2227 Piedmont Ave
Suite 150 Sports Medicine
Berkeley, CA 94720

Phone

(510) 642-4878

NPI assigned

Jul 28, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1346254182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UC BERKELEY ATHLETICS - 2227 PIEDMONT AVE",
            "address_2": "SUITE 150 SPORTS MEDICINE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94720",
            "telephone_number": "954-224-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UC BERKELEY ATHLETICS - 2227 PIEDMONT AVE",
            "address_2": "SUITE 150 SPORTS MEDICINE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94720",
            "telephone_number": "510-642-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLG",
        "first_name": "KRISTY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT28806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT28806",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond E Ifield
• Gerald John Iglesias
• Allison Mayumi Ikeda, MFT
• Ashley Kimiko Ikeda
• Amanda Marie Ilag, AGNP
• Michel Lynn Inaba, PH.D.
• Erin Inada, MS, CCC-SLP
• Inadvance Medicine Associates West, P.C
• Pamela Renee Inbar-Hansen, MSPT
• Inclusive Community Resources LLC

• All providers in Berkeley, CA
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.