1619148673 NPI number — MRS. KELLEY C HOYT MS PT

Table of content: MRS. KELLEY C HOYT MS PT (NPI 1619148673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619148673 NPI number — MRS. KELLEY C HOYT MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOYT
Provider First Name:
KELLEY
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619148673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 S VAN BUREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST DUNDEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60118-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-670-4216
Provider Business Mailing Address Fax Number:
224-333-5747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-8032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-893-0439
Provider Business Practice Location Address Fax Number:
844-859-5959
Provider Enumeration Date:
03/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070005319 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)