Provider Demographics
NPI:1689807505
Name:PONG, CHRISTINE (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:PONG
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2951
Mailing Address - Country:US
Mailing Address - Phone:708-367-8050
Mailing Address - Fax:
Practice Address - Street 1:1397 MAIN ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2951
Practice Address - Country:US
Practice Address - Phone:708-367-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist