Healthcare Provider Details

I. General information

NPI: 1982925178
Provider Name (Legal Business Name): CHRISTOPHER BALUYOT TEIMOURI R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMED NASSER BALUYOT TEIMOURI R.P.T

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 N CUMBERLAND AVE 101-A
CHICAGO IL
60656-1490
US

IV. Provider business mailing address

5440 N CUMBERLAND AVE 101-A
CHICAGO IL
60656-1490
US

V. Phone/Fax

Practice location:
  • Phone: 773-444-0400
  • Fax:
Mailing address:
  • Phone: 773-444-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: