1558697300 NPI number — MRS. KATHLEEN MARIE NEWHOUSE DPT

Table of content: MRS. KATHLEEN MARIE NEWHOUSE DPT (NPI 1558697300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558697300 NPI number — MRS. KATHLEEN MARIE NEWHOUSE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWHOUSE
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558697300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13524 JULIE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61065-7829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-765-1155
Provider Business Mailing Address Fax Number:
815-765-1166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13524 JULIE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61065-7829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-765-1155
Provider Business Practice Location Address Fax Number:
815-765-1166
Provider Enumeration Date:
10/29/2009

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:  070.016847 , 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)





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