Provider Demographics
NPI:1689357162
Name:BECKER, CHRISTIAN HENRY (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:HENRY
Last Name:BECKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W TOUHY AVENUE
Mailing Address - Street 2:UNIT #316
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:224-402-1815
Mailing Address - Fax:
Practice Address - Street 1:170 JAMESTOWN LN
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-2119
Practice Address - Country:US
Practice Address - Phone:224-543-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009488225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant