Healthcare Provider Details

I. General information

NPI: 1730435256
Provider Name (Legal Business Name): DANIELLE MARIE MCKENNA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N NORTHWEST HWY STE 202
PARK RIDGE IL
60068-3271
US

IV. Provider business mailing address

341 MONTGOMERY LN
GLENVIEW IL
60025-4977
US

V. Phone/Fax

Practice location:
  • Phone: 847-268-0280
  • Fax:
Mailing address:
  • Phone: 834-781-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070018787
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070018787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: