Provider Demographics
NPI:1386991628
Name:BRAUER, CHRISTINE SUZANNE (DPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:SUZANNE
Last Name:BRAUER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:SUZANNE
Other - Last Name:TABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD STE 1020
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:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:735 HIGHGROVE PL
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2520
Practice Address - Country:US
Practice Address - Phone:815-226-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist