MEDICARE: REID KELSO KIGER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070.028642	IL

General Provider Information

NPI Number	:	1609614528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID KELSO KIGER DPT

Provider Business Mailing Address
First Line	:	1236 N WOLCOTT AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3131
Country	:	US
Telephone Number	:	816-721-7030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 W ROOSEVELT RD # DHSP338
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1316
Country	:	US
Telephone Number	:	312-413-8043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	09/16/2024

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Directions to “ REID KELSO KIGER DPT” Practice Location

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