Healthcare Provider Details

I. General information

NPI: 1164896858
Provider Name (Legal Business Name): KRISTIA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

1254 ADLER LN
CAROL STREAM IL
60188-1392
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070021887
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: