Basic Information
| Provider Information | |||||||||
| NPI: | 1932798584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILHELM | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | REID | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663708206 | ||||||||
| FaxNumber: | 5174353670 | ||||||||
| Practice Location | |||||||||
| Address1: | 4110 S 144TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681371013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028616683 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2021 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4129 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.