Provider Demographics
NPI:1013385129
Name:CHRISTIANSEN, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3084
Mailing Address - Country:US
Mailing Address - Phone:847-854-0196
Mailing Address - Fax:
Practice Address - Street 1:1140 E ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3084
Practice Address - Country:US
Practice Address - Phone:847-854-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist