Healthcare Provider Details

I. General information

NPI: 1740390095
Provider Name (Legal Business Name): KATHLEEN A RYAN CEISEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN RYAN PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 S MAIN ST
ALGONQUIN IL
60102-2741
US

IV. Provider business mailing address

1541 SOUTHRIDGE TRL
ALGONQUIN IL
60102-6602
US

V. Phone/Fax

Practice location:
  • Phone: 224-505-3343
  • Fax:
Mailing address:
  • Phone: 847-987-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number070007182
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070007182
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier568080
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE GROUP NUMBER
# 2
IdentifierDC7571
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerR.R. GROUP #
# 3
Identifier1623066
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS PROVIDER #
# 4
Identifier367885100
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerU S DEPT OF LABOR PROV#
# 5
Identifier567700
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE GROUP NUMBER
# 6
Identifier568150
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE GROUP NUMBER
# 7
Identifier1619908
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS IL GROUP NUMBER
# 8
IdentifierP00304982
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerR.R. MEDICARE PIN #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: