Healthcare Provider Details

I. General information

NPI: 1699756130
Provider Name (Legal Business Name): KATHLEEN IFFLAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN MAGUIGAN

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BECKS WOODS DR
BEAR DE
19701-3835
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 302-392-3400
  • Fax: 302-392-3401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10000561
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: