Healthcare Provider Details

I. General information

NPI: 1023612660
Provider Name (Legal Business Name): KRISTIN LIEBL PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MARQUETTE DR
ROMEOVILLE IL
60446-1026
US

IV. Provider business mailing address

653 N KINGSBURY ST APT 1404
CHICAGO IL
60654-7087
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-2932
  • Fax:
Mailing address:
  • Phone: 312-593-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN E LIEBL
Title or Position: PT
Credential: PT, DPT, NCS
Phone: 312-593-4277