Provider Demographics
NPI:1487091187
Name:CARD, KATRENA (PT, DPT, CWS)
Entity type:Individual
Prefix:
First Name:KATRENA
Middle Name:
Last Name:CARD
Suffix:
Gender:F
Credentials:PT, DPT, CWS
Other - Prefix:
Other - First Name:KATRENA
Other - Middle Name:
Other - Last Name:KENNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5623
Mailing Address - Country:US
Mailing Address - Phone:224-456-6202
Mailing Address - Fax:
Practice Address - Street 1:33 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5623
Practice Address - Country:US
Practice Address - Phone:224-456-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist