Provider Demographics
NPI:1063692622
Name:FISSEL, CHRISTINE M (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:FISSEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1753 KENDARBREN DR
Practice Address - Street 2:SUITE 610
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1043
Practice Address - Country:US
Practice Address - Phone:215-343-2141
Practice Address - Fax:215-343-4151
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-008269L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist