Provider Demographics
NPI:1093921918
Name:LOUDERMAN, CHRISTEN L (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:L
Last Name:LOUDERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:L
Other - Last Name:EUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:110 W WOODSTOCK ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4239
Mailing Address - Country:US
Mailing Address - Phone:815-893-9075
Mailing Address - Fax:
Practice Address - Street 1:110 W WOODSTOCK ST STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4239
Practice Address - Country:US
Practice Address - Phone:815-893-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6238019OtherMEDICARE
ILIL6237019OtherMEDICARE
ILIL6697009OtherMEDICARE