Healthcare Provider Details

I. General information

NPI: 1609140466
Provider Name (Legal Business Name): KATHERINE E CHRISTOPHERSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 E LINCOLN HWY
NEW LENOX IL
60451-9712
US

IV. Provider business mailing address

1801 E LINCOLN HWY
NEW LENOX IL
60451-3801
US

V. Phone/Fax

Practice location:
  • Phone: 313-310-9105
  • Fax:
Mailing address:
  • Phone: 313-310-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.003078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: