1912928920 NPI number — CHRISTINE ANN KLODY DPT,MPT, CSCS

Table of content: CHRISTINE ANN KLODY DPT,MPT, CSCS (NPI 1912928920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912928920 NPI number — CHRISTINE ANN KLODY DPT,MPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLODY
Provider First Name:
CHRISTINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT,MPT, CSCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUCCIO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, MPT, CSCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912928920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6013 RIVER BEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-2194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-286-7147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 CENTRE POINT CIR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-955-1940
Provider Business Practice Location Address Fax Number:
630-955-1944
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070013512 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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