Provider Demographics
NPI:1790877231
Name:ZEGERS, CHRISTA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ANNE
Last Name:ZEGERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:ANNE
Other - Last Name:DE ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:3233 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4328
Practice Address - Country:US
Practice Address - Phone:773-478-0496
Practice Address - Fax:773-478-1251
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00898837OtherMEDICARE RAILROAD
IL216859027Medicare PIN
ILP00615509Medicare PIN
ILP00898837OtherMEDICARE RAILROAD
IL202845055Medicare PIN
ILK25019Medicare PIN