Healthcare Provider Details

I. General information

NPI: 1225013303
Provider Name (Legal Business Name): CHRISTIE DIANE KARLE PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5772 BOLSA AVE STE 101
HUNTINGTON BEACH CA
92649-1134
US

IV. Provider business mailing address

5962 LA PLACE CT STE 170
CARLSBAD CA
92008-8807
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-3589
  • Fax: 714-897-1316
Mailing address:
  • Phone: 800-929-4776
  • Fax: 760-931-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: