Healthcare Provider Details

I. General information

NPI: 1962605188
Provider Name (Legal Business Name): KATHRYN MARY HUETTL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE KOREN PT, DPT, OCS

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 127TH ST STE 221A
LEMONT IL
60439-2914
US

IV. Provider business mailing address

15900 W 127TH ST STE 221A
LEMONT IL
60439-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-421-1016
  • Fax:
Mailing address:
  • Phone: 312-421-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015827
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: