Provider Demographics
NPI:1003190125
Name:CHRISTINA L ANDERSON MPT INC
Entity Type:Organization
Organization Name:CHRISTINA L ANDERSON MPT INC
Other - Org Name:A BRIGHT START PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:815-937-0966
Mailing Address - Street 1:1786 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-6249
Mailing Address - Country:US
Mailing Address - Phone:815-937-0966
Mailing Address - Fax:
Practice Address - Street 1:1786 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-6249
Practice Address - Country:US
Practice Address - Phone:815-937-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013582261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy