Provider Demographics
NPI:1689686008
Name:RICHARD, KRISTEN (PT, OCS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MARKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:10730 W 143RD ST STE 31
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1975
Mailing Address - Country:US
Mailing Address - Phone:708-966-2945
Mailing Address - Fax:708-966-2958
Practice Address - Street 1:10730 W 143RD ST STE 31
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1975
Practice Address - Country:US
Practice Address - Phone:708-966-2945
Practice Address - Fax:708-966-2958
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist