Provider Demographics
NPI:1003555699
Name:FERNANDEZ, CHRISTELLE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTELLE ANNE TH
Other - Middle Name:CUSIT
Other - Last Name:MACACHOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:4765 S DURANGO DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8158
Practice Address - Country:US
Practice Address - Phone:702-898-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist