1578035986 NPI number — NISA CHRISTIE PT

Table of content: NISA CHRISTIE PT (NPI 1578035986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578035986 NPI number — NISA CHRISTIE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIE
Provider First Name:
NISA
Provider Middle Name:
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:
MANN
Provider Other First Name:
NISA
Provider Other Middle Name:
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:
1578035986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02563-8019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-778-9336
Provider Business Mailing Address Fax Number:
508-888-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-3825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-6685
Provider Business Practice Location Address Fax Number:
508-771-5774
Provider Enumeration Date:
12/24/2018

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: 208100000X , with the licence number:  24017 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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