Provider Demographics
NPI:1538416813
Name:MURPHY, KELLY DAWN (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6719
Mailing Address - Country:US
Mailing Address - Phone:708-227-5508
Mailing Address - Fax:708-252-3838
Practice Address - Street 1:521 S LA GRANGE RD STE 102
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5633
Practice Address - Country:US
Practice Address - Phone:708-794-6452
Practice Address - Fax:708-252-3838
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist