Provider Demographics
NPI:1194185769
Name:TITO, CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TITO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BLASDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:OAK BROOK
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:13311 S ROUTE 59
Practice Address - Street 2:PLAINFIELD
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5893
Practice Address - Country:US
Practice Address - Phone:815-577-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist