Provider Demographics
NPI:1053518001
Name:CHRISTAIN, HEATHER M (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:CHRISTAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:RALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1781 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3532
Mailing Address - Country:US
Mailing Address - Phone:847-452-4066
Mailing Address - Fax:
Practice Address - Street 1:1781 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3532
Practice Address - Country:US
Practice Address - Phone:847-452-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT001936225100000X
PAPT0194602251X0800X
IL070015852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK40302Medicare PIN
ILP00615498Medicare PIN
ILK46370Medicare PIN