Provider Demographics
NPI:1235532409
Name:HOLLIS, CHRISTIAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LEE
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1404
Mailing Address - Country:US
Mailing Address - Phone:630-264-8440
Mailing Address - Fax:630-264-8444
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-264-8440
Practice Address - Fax:630-264-8444
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400170235Medicare PIN