Healthcare Provider Details

I. General information

NPI: 1730304056
Provider Name (Legal Business Name): ADRIENNE KLEIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/17/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERRYMAN ST
LEBANON IL
62254-1356
US

IV. Provider business mailing address

812 TANZANITE LN
MASCOUTAH IL
62258-2953
US

V. Phone/Fax

Practice location:
  • Phone: 618-537-6165
  • Fax:
Mailing address:
  • Phone: 618-580-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: