Healthcare Provider Details

I. General information

NPI: 1578477253
Provider Name (Legal Business Name): RICK CHRISTMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 CR 604
BUSHNELL FL
33513-3508
US

IV. Provider business mailing address

1332 CR 604
BUSHNELL FL
33513-3508
US

V. Phone/Fax

Practice location:
  • Phone: 352-631-9601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: