Healthcare Provider Details

I. General information

NPI: 1013044536
Provider Name (Legal Business Name): KAMIN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 BUSSE HWY SUITE C
PARK RIDGE IL
60068-2441
US

IV. Provider business mailing address

770 BUSSE HWY SUITE C
PARK RIDGE IL
60068-2441
US

V. Phone/Fax

Practice location:
  • Phone: 847-384-6804
  • Fax: 847-384-6806
Mailing address:
  • Phone: 847-384-6804
  • Fax: 847-384-6806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070013246
License Number StateIL

VIII. Authorized Official

Name: DR. HEATHER L MOKY
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 847-384-6804