Healthcare Provider Details

I. General information

NPI: 1831177005
Provider Name (Legal Business Name): KRISTEN J. DALY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S RIVERSIDE PLZ
CHICAGO IL
60606-5808
US

IV. Provider business mailing address

3703 MUSTANG RD
JOLIET IL
60435-8811
US

V. Phone/Fax

Practice location:
  • Phone: 312-416-3804
  • Fax:
Mailing address:
  • Phone: 708-846-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: