Provider Demographics
NPI:1821465816
Name:WALTERS, CHRISTOPHER MICHAEL (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PT, DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12531 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6500
Mailing Address - Country:US
Mailing Address - Phone:847-659-1000
Mailing Address - Fax:847-659-1012
Practice Address - Street 1:12531 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6500
Practice Address - Country:US
Practice Address - Phone:847-659-1000
Practice Address - Fax:847-659-1012
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400247785Medicare PIN
ILF400247787Medicare PIN