Healthcare Provider Details

I. General information

NPI: 1609614528
Provider Name (Legal Business Name): REID KELSO KIGER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W ROOSEVELT RD # DHSP338
CHICAGO IL
60608-1316
US

IV. Provider business mailing address

1236 N WOLCOTT AVE UNIT 2
CHICAGO IL
60622-3131
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-8043
  • Fax:
Mailing address:
  • Phone: 816-721-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.028642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: