Provider Demographics
NPI:1962621037
Name:BRIGHTMORE, KATHLEEN A (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:BRIGHTMORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:BRIGHTMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1240 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8408
Mailing Address - Country:US
Mailing Address - Phone:815-744-7108
Mailing Address - Fax:815-773-7513
Practice Address - Street 1:1240 ESSINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8408
Practice Address - Country:US
Practice Address - Phone:815-744-7108
Practice Address - Fax:815-773-7513
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist