Provider Demographics
NPI:1659676096
Name:DIMAGIBA, CHRISTOPHER CUARESMA (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CUARESMA
Last Name:DIMAGIBA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14725 S PENN RD
Mailing Address - Street 2:APARTMENT 10
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2235
Mailing Address - Country:US
Mailing Address - Phone:815-661-0911
Mailing Address - Fax:
Practice Address - Street 1:14725 S PENN RD
Practice Address - Street 2:APARTMENT 10
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2235
Practice Address - Country:US
Practice Address - Phone:815-661-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist