Provider Demographics
NPI:1194935189
Name:STEC, KEITH (PT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:STEC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:7055 GRAND AVE
Practice Address - Street 2:SUITE 4C
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1603
Practice Address - Country:US
Practice Address - Phone:224-321-5596
Practice Address - Fax:847-855-0860
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070002943OtherLICENSE NUMBER