Provider Demographics
NPI:1508178500
Name:PREISSLER, CHRISTINE R (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:PREISSLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:R
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1301 W MADISON ST STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1940
Practice Address - Country:US
Practice Address - Phone:312-243-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
IL070017976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01328513OtherRAILROAD MEDICARE
ILP01328513OtherRAILROAD MEDICARE
IL216859045Medicare PIN