Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070015852 | IL |
N | 225100000X | Physical Therapist | DAPT001936 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT019460 | PA |
NPI | 1053518001 |
---|---|
Provider Name | Heather M Christain |
First Address | Highland Park, IL 60035-3532 |
Second Address | Highland Park, IL 60035-3532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 25/09/2019 |