1003078544 NPI number — CHRISTINA R MITMAN PT

Table of content: CHRISTINA R MITMAN PT (NPI 1003078544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003078544 NPI number — CHRISTINA R MITMAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITMAN
Provider First Name:
CHRISTINA
Provider Middle Name:
R
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:
1003078544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848269
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-973-1700
Provider Business Mailing Address Fax Number:
610-973-1778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 CETRONIA ROAD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-9168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-973-6200
Provider Business Practice Location Address Fax Number:
610-973-6535
Provider Enumeration Date:
06/26/2008

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:  PT019436 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: PT019436 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: PT019436 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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