Provider Demographics
NPI:1811098593
Name:LASK, CHRISTOPHER M (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:LASK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 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:630-759-3251
Practice Address - Street 1:14035 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8463
Practice Address - Country:US
Practice Address - Phone:708-645-0423
Practice Address - Fax:708-645-0428
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00943111OtherMEDICARE RAILROAD
ILK02434Medicare PIN
ILR03884Medicare PIN
ILR03885Medicare PIN
ILP00224827Medicare PIN
ILK45564Medicare PIN
ILK45563Medicare PIN
IL216859183Medicare PIN
ILP00447962Medicare PIN
ILF400109165Medicare PIN