Provider Demographics
NPI:1538284179
Name:SWEENEY, KATHLEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SWEENEY
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 1:1723 N NEWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4410
Mailing Address - Country:US
Mailing Address - Phone:773-350-3409
Mailing Address - Fax:
Practice Address - Street 1:2211 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:773-385-5573
Practice Address - Fax:773-385-5851
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700137372251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics