Provider Demographics
NPI:1982925178
Name:TEIMOURI, CHRISTOPHER BALUYOT (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BALUYOT
Last Name:TEIMOURI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:MOHAMMED NASSER
Other - Middle Name:BALUYOT
Other - Last Name:TEIMOURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:5440 N CUMBERLAND AVE
Mailing Address - Street 2:101-A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1490
Mailing Address - Country:US
Mailing Address - Phone:773-444-0400
Mailing Address - Fax:
Practice Address - Street 1:5440 N CUMBERLAND AVE
Practice Address - Street 2:101-A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1490
Practice Address - Country:US
Practice Address - Phone:773-444-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist