Provider Demographics
NPI:1710132964
Name:CONCHA, CHRISTINE (BSPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CONCHA
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:SASO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1031 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3960
Practice Address - Country:US
Practice Address - Phone:847-895-1866
Practice Address - Fax:847-895-1877
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032819225100000X
IL070.015775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist