Provider Demographics
NPI:1124220066
Name:STAHR, KRISTY (PT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:STAHR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1657
Mailing Address - Country:US
Mailing Address - Phone:847-581-6300
Mailing Address - Fax:
Practice Address - Street 1:1824 JOHNS DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-581-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03810Medicare PIN
ILR00793Medicare PIN
IL211585004Medicare PIN
IL205782003Medicare PIN
ILR03811Medicare PIN
IL216859098Medicare PIN