Kristin Charleston, PTA
Individual provider Active NPI Physical Therapy Assistant · Mount Morris, IL
NPI 1447898671 · NPPES record last updated Dec 18, 2019
Key facts
- NPI
- 1447898671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.007379 (IL)
- Practice address
- 414 S Wesley Ave
Mount Morris, IL 61054-1428 - Phone
- (815) 734-4103
- NPI assigned
- Dec 18, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.007379 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.007379 | IL | Yes |
Addresses
Primary practice location
414 S Wesley Ave
Mount Morris, IL 61054-1428
Mailing address
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Other providers in Mount Morris, IL
- Brethren Home
- Brethren Home
- Brethren Home
- Whitney Ann Cervantez
- Isaac Heonsang Cha
- Bruce E Denton
- Noel Dusing
- Alyssa J Ervin
- Felker Pharmacy Inc
- Kristen Gilbert
All providers in Mount Morris, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.