Provider Demographics
NPI:1508062902
Name:CHRISTIAN, KRISTIN M (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:HERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3266 RESOURCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-5330
Mailing Address - Country:US
Mailing Address - Phone:815-756-8524
Mailing Address - Fax:815-756-1841
Practice Address - Street 1:3266 RESOURCE PARKWAY
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-5330
Practice Address - Country:US
Practice Address - Phone:815-756-8524
Practice Address - Fax:815-756-1841
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014411225100000X
IL070-014411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK39561Medicare UPIN