Provider Demographics
NPI:1912928920
Name:KLODY, CHRISTINE ANN (DPT,MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:KLODY
Suffix:
Gender:F
Credentials:DPT,MPT, CSCS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:PUCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, MPT, CSCS
Mailing Address - Street 1:6013 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2194
Mailing Address - Country:US
Mailing Address - Phone:312-286-7147
Mailing Address - Fax:
Practice Address - Street 1:1804 CENTRE POINT CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1440
Practice Address - Country:US
Practice Address - Phone:630-955-1940
Practice Address - Fax:630-955-1944
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist