Kelly Kuntzendorf
Individual provider Active NPI Physical Therapy Assistant · Plano, IL
NPI 1710362124 · NPPES record last updated Jul 27, 2015
Key facts
- NPI
- 1710362124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.006829 (IL)
- Practice address
- 4106 Cummins St
Plano, IL 60545-2220 - Phone
- (630) 220-1193
- NPI assigned
- Jul 27, 2015
- 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 |
|---|---|---|---|
| 160.006829 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.006829 | IL | Yes |
Addresses
Primary practice location
4106 Cummins St
Plano, IL 60545-2220
Mailing address
4106 Cummins St
Plano, IL 60545-2220
Phone (630) 220-1193
Other providers in Plano, IL
- Impact Physician Group, Illinois LLC
- Ashlie Jones
- Kea Sports Company
- Kipngetich N Korir
- Snehal K Kulkarni
- Robert Latham II
- Ryan D Lee
- Little Rock Fox Fire Protection District
- Jacqueline Locasto
- Caroline Locker
All providers in Plano, 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 Jul 27, 2015. 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.