Provider Demographics
NPI:1235386863
Name:FOTOPOULOS, KERRI A (DPT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:FOTOPOULOS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:A
Other - Last Name:POWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3233 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4328
Practice Address - Country:US
Practice Address - Phone:773-478-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00860003OtherMEDICARE RR
ILR03861Medicare PIN
ILF400145738Medicare PIN