1700992997 NPI number — CHRISTINE MARIE BASIC-KROWIARZ PT

Table of content: CHRISTINE MARIE BASIC-KROWIARZ PT (NPI 1700992997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700992997 NPI number — CHRISTINE MARIE BASIC-KROWIARZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASIC-KROWIARZ
Provider First Name:
CHRISTINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALLACE
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700992997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 W 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28658-2852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-485-4594
Provider Business Mailing Address Fax Number:
828-330-2096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28658-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-485-4594
Provider Business Practice Location Address Fax Number:
828-330-2096
Provider Enumeration Date:
08/21/2006

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:  P15415 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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