Provider Demographics
NPI:1396013207
Name:MICHALAK CHALABI, KRISTEY
Entity Type:Individual
Prefix:MRS
First Name:KRISTEY
Middle Name:
Last Name:MICHALAK CHALABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2937
Mailing Address - Country:US
Mailing Address - Phone:847-858-2311
Mailing Address - Fax:
Practice Address - Street 1:6043 CAROL AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2937
Practice Address - Country:US
Practice Address - Phone:847-858-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004247225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant