Provider Demographics
NPI:1063820108
Name:PUTNAM, CHRISTIE L (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:L
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:L
Other - Last Name:ADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:142 E 600 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60918-9784
Mailing Address - Country:US
Mailing Address - Phone:815-474-5228
Mailing Address - Fax:
Practice Address - Street 1:1001 E PELLS ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1300
Practice Address - Country:US
Practice Address - Phone:217-379-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist