Provider Demographics
NPI:1356389720
Name:EVERETT, CHRISTINE KATHERINE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KATHERINE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3704
Mailing Address - Country:US
Mailing Address - Phone:847-570-7170
Mailing Address - Fax:
Practice Address - Street 1:1729 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3704
Practice Address - Country:US
Practice Address - Phone:847-570-7170
Practice Address - Fax:847-570-7172
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP
IL568080OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
ILK50411Medicare PIN
ILK27970Medicare PIN
ILK50410Medicare PIN