Healthcare Provider Details

I. General information

NPI: 1841518214
Provider Name (Legal Business Name): SHANNON K KLEINFELDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MANTENO IL
60950-9466
US

IV. Provider business mailing address

1 VETERANS DR
MANTENO IL
60950-9466
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-6581
  • Fax:
Mailing address:
  • Phone: 815-468-6581
  • 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 Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070.018024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: