Provider Demographics
NPI:1568076529
Name:STALLKNECHT, CHRISTINA ALEXIS (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALEXIS
Last Name:STALLKNECHT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 N SHERIDAN RD APT 11N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6557
Mailing Address - Country:US
Mailing Address - Phone:706-247-0831
Mailing Address - Fax:
Practice Address - Street 1:4715 N SHERIDAN RD APT 11N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6557
Practice Address - Country:US
Practice Address - Phone:706-247-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227016836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist