1467643429 NPI number — CHRISTIE JANE THAMES AMUNDSON PT, DPT, PRC, HFS

Table of content: CHRISTIE JANE THAMES AMUNDSON PT, DPT, PRC, HFS (NPI 1467643429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467643429 NPI number — CHRISTIE JANE THAMES AMUNDSON PT, DPT, PRC, HFS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMUNDSON
Provider First Name:
CHRISTIE
Provider Middle Name:
JANE THAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, PRC, HFS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THAMES
Provider Other First Name:
CHRISTIE
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, PRC, HFS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467643429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 UNIVERSITY AVE W
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104-3898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-999-1029
Provider Business Mailing Address Fax Number:
651-641-0726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 UNIVERSITY AVE W
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-3898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-999-1029
Provider Business Practice Location Address Fax Number:
651-641-0726
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8453 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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