Individual
GARY JOSEPH KISTENFEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1400 MIDTOWN RD, PERU, IL 61354-1269
(815) 223-8600
Mailing address
1400 MIDTOWN RD, PERU, IL 61354-1269
(815) 223-8600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.005952
IL
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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