Individual
SHANNON K KLEINFELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1 VETERANS DR, MANTENO, IL 60950-9466
(815) 468-6581
Mailing address
1 VETERANS DR, MANTENO, IL 60950-9466
(815) 468-6581
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
IL
2251G0304X
Geriatric Physical Therapist
Primary
070.018024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00865618
MEDICARE RR
IL
Enumeration date
05/11/2010
Last updated
11/03/2023
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