Provider Demographics
NPI:1750460598
Name:MANUEL, CHRISTY L (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:MANUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:L
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5662 WALNUT AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 S NAPER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8360
Practice Address - Country:US
Practice Address - Phone:630-369-2340
Practice Address - Fax:630-369-2859
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22769Medicare PIN
ILR00827Medicare PIN
ILK53186Medicare PIN