Provider Demographics
NPI:1235731308
Name:HIPSHER, CHRISTOPHER RAY
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:HIPSHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MANITO
Mailing Address - State:IL
Mailing Address - Zip Code:61546-8778
Mailing Address - Country:US
Mailing Address - Phone:309-397-4879
Mailing Address - Fax:
Practice Address - Street 1:1500 W NORTHMOOR RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3435
Practice Address - Country:US
Practice Address - Phone:309-691-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160008900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant