Healthcare Provider Details

I. General information

NPI: 1821745175
Provider Name (Legal Business Name): KRISTA L SEMINETTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA L GOTTWALD DPT

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 MAIN ST
EVANSTON IL
60202-1815
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-1630
  • Fax: 847-475-1631
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-027080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: