Healthcare Provider Details

I. General information

NPI: 1013385905
Provider Name (Legal Business Name): KATHERINE M CEISEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 GREEN BAY RD
WINNETKA IL
60093-1853
US

IV. Provider business mailing address

8000 S LINCOLN ST STE 6
LITTLETON CO
80122-2704
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5788
  • Fax: 847-784-8720
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070021695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: