Healthcare Provider Details

I. General information

NPI: 1053475103
Provider Name (Legal Business Name): KENNETH MICHAEL ORR JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 SOUTHWEST HWY
OAK LAWN IL
60453-2862
US

IV. Provider business mailing address

2514 BURR OAK AVE
BLUE ISLAND IL
60406-2027
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-0101
  • Fax: 708-229-0090
Mailing address:
  • Phone: 708-715-2335
  • Fax: 708-229-0090

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: