Provider Demographics
NPI:1104226489
Name:MCKECHNIE, KATE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MCKECHNIE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:CYSEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:211 N CLINTON ST STE 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1283
Mailing Address - Country:US
Mailing Address - Phone:877-709-1090
Mailing Address - Fax:866-221-3400
Practice Address - Street 1:914 GREEN BAY RD STE 202
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1701
Practice Address - Country:US
Practice Address - Phone:877-709-1090
Practice Address - Fax:866-221-3400
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400168646Medicare PIN