1073707956 NPI number — CHRISTINA LYNN WEBB PT

Table of content: RAMANOU ODJOUOLA (NPI 1013351493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073707956 NPI number — CHRISTINA LYNN WEBB PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
CHRISTINA
Provider Middle Name:
LYNN
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073707956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25101 N LAKE PLEASANT PKWY STE B-1340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85383-1386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-471-5550
Provider Business Mailing Address Fax Number:
623-471-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25101 N LAKE PLEASANT PKWY STE B-1340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85383-1386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-471-5550
Provider Business Practice Location Address Fax Number:
623-471-5551
Provider Enumeration Date:
09/04/2007

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:  007787 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007787 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7787 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".