Provider Demographics
NPI:1073621041
Name:CHRISTEN, KAREN (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHRISTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:2100 NW 100TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-5329
Practice Address - Country:US
Practice Address - Phone:515-331-0986
Practice Address - Fax:515-331-0988
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665711Medicaid
IA32071OtherBLUE CROSS BLUE SHIELD
WI5555OtherLICENSE#
IL070.016415OtherSTATE LICENSE
IA3999OtherSTATE LICENSE
IAI19449OtherMEDICARE
IAI19449Medicare PIN