Healthcare Provider Details

I. General information

NPI: 1598349052
Provider Name (Legal Business Name): KAILEY BECKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S STATE ST STE 300
CHICAGO IL
60605-2775
US

IV. Provider business mailing address

24014 W RENWICK RD STE F
PLAINFIELD IL
60544-8708
US

V. Phone/Fax

Practice location:
  • Phone: 312-877-5101
  • Fax: 312-877-5906
Mailing address:
  • Phone: 800-974-4378
  • Fax: 630-515-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.025332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: