Provider Demographics
NPI:1588695407
Name:SCHNEIDER, KATHERINE M (PT DPT ATC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PT DPT ATC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:LUTGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT ATC
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:192 W ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1324
Practice Address - Country:US
Practice Address - Phone:847-201-4706
Practice Address - Fax:847-201-8708
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6697001OtherMEDICARE
WI40460200Medicaid
ILIL6238011OtherMEDICARE
ILIL6237011OtherMEDICARE
ILK17186Medicare ID - Type Unspecified
ILIL6238011OtherMEDICARE
ILK09661Medicare ID - Type Unspecified