Healthcare Provider Details

I. General information

NPI: 1912035734
Provider Name (Legal Business Name): CHRISTINA MARIE SIMON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 ESSINGTON RD STE B
JOLIET IL
60435-2871
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-2000
  • Fax: 815-314-5170
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: