Basic Information
| Provider Information | |||||||||
| NPI: | 1225429541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEGEMAN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | HALLADA | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
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| OtherCredential: | PT,MSPT, ATC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 7057 DEXTER ANN ARBOR RD | ||||||||
| Address2: | |||||||||
| City: | DEXTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481308568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344261406 | ||||||||
| FaxNumber: | 7344261406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501002993 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.