Provider Demographics
NPI:1063386498
Name:MOLINA-GODINEZ, CHRISTIAN JOSEPH (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOSEPH
Last Name:MOLINA-GODINEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16744 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3135
Mailing Address - Country:US
Mailing Address - Phone:708-664-4650
Mailing Address - Fax:
Practice Address - Street 1:1870 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3013
Practice Address - Country:US
Practice Address - Phone:872-287-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.024293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty