MEDICARE: MARK J KORTENHOEVEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070010698	IL

General Provider Information

NPI Number	:	1699888099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J KORTENHOEVEN PT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 E GENEVA RD
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2438
Country	:	US
Telephone Number	:	630-653-6336
Fax Number	:	630-653-6446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/10/2018

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