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General NPI Number Information
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NPI Number | 1083683486
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Entity Type | Individual
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Provider Name | KRISTINE M MYREN ATC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2401 RAVINE WAY
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City | GLENVIEW
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State | IL
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Zip | 60025-7645
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Country | US
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Telephone | 847-724-4791
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Fax |
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Provider Business Mailing Address
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Address Line | 8056 LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3692
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Country | US
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Telephone | 605-421-5003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 96002226
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License Number State | IL
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