Provider Demographics
NPI:1538224746
Name:PALM, KERRY KEANE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:KEANE
Last Name:PALM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1237
Mailing Address - Country:US
Mailing Address - Phone:708-784-1596
Mailing Address - Fax:312-942-4809
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:412 JONES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-6318
Practice Address - Fax:312-942-4809
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist