Healthcare Provider Details

I. General information

NPI: 1619115102
Provider Name (Legal Business Name): CHRISTINA TRAUTHWEIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA TRAUTHWEIN PTA

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10341 SE US HIGHWAY 441
BELLEVIEW FL
34420-2807
US

IV. Provider business mailing address

8455 S SUNCOAST BLVD
HOMOSASSA FL
34446-5066
US

V. Phone/Fax

Practice location:
  • Phone: 352-307-0066
  • Fax: 352-307-9556
Mailing address:
  • Phone: 352-567-5910
  • Fax: 352-567-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: