Doctor Name: | MR. TIMOTHY DALE KISNER |
NPI Number: | 1689650004 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.P.T. |
License Number: | 070-011706 |
Business Practice Address: | 4700 Gilbert Ave Suite 43a Western Springs, IL - 605581753 |
Business Phone Number: | 7087831044 |
Business Fax Number: | 7087831048 |
Mailing Address: | 205 W Wacker Dr, Suite 1020 CHICAGO |
State: | IL |
Postal Code: | 606061216 |
Phone Number: | 3126400329 |
Fax Number: | |
NPI Enumeration Date: | 12/16/2005 |
NPI Last Update Date: | 08/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 070-011706 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |