Provider Demographics
NPI:1255528105
Name:SUDKAMP, KASEY LYNN (DPT)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:LYNN
Last Name:SUDKAMP
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 1:15328 N 1800TH ST
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-3370
Mailing Address - Country:US
Mailing Address - Phone:217-821-9488
Mailing Address - Fax:
Practice Address - Street 1:15328 N 1800TH ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-3370
Practice Address - Country:US
Practice Address - Phone:217-821-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist