Healthcare Provider Details

I. General information

NPI: 1548040868
Provider Name (Legal Business Name): KELLY TRAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4657 N LINCOLN AVE
CHICAGO IL
60625-2024
US

IV. Provider business mailing address

3113 W LAWRENCE AVE APT 202
CHICAGO IL
60625-3656
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-6472
  • Fax:
Mailing address:
  • Phone: 312-608-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: