Provider Demographics
NPI:1730166018
Name:KOLKEBECK, DENNY (DPT)
Entity type:Individual
Prefix:DR
First Name:DENNY
Middle Name:
Last Name:KOLKEBECK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-6109
Mailing Address - Country:US
Mailing Address - Phone:815-761-7262
Mailing Address - Fax:
Practice Address - Street 1:2445 BETHANY RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3130
Practice Address - Country:US
Practice Address - Phone:815-761-7262
Practice Address - Fax:888-972-6580
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650018275OtherRAILROAD MEDICARE
650018275OtherRAILROAD MEDICARE