Provider Demographics
NPI:1598819039
Name:KENRON, CHRISTINA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:KENRON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1063
Mailing Address - Country:US
Mailing Address - Phone:847-791-1505
Mailing Address - Fax:847-966-1505
Practice Address - Street 1:9436 OZARK AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1063
Practice Address - Country:US
Practice Address - Phone:847-791-1505
Practice Address - Fax:847-966-1505
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist