Provider Demographics
NPI:1750789038
Name:STROMBERG, KRISTIN (ATC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SPRINGFIELD DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2214
Mailing Address - Country:US
Mailing Address - Phone:630-924-1111
Mailing Address - Fax:630-924-0841
Practice Address - Street 1:290 SPRINGFIELD DR
Practice Address - Street 2:SUITE 255
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2214
Practice Address - Country:US
Practice Address - Phone:630-924-1111
Practice Address - Fax:630-924-0841
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960028542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer