Healthcare Provider Details

I. General information

NPI: 1588970099
Provider Name (Legal Business Name): CHRISTINE M LEFKO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE M LEFKO

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45390 GREEN AVE
CALLAHAN FL
32011-3711
US

IV. Provider business mailing address

85083 CHRISTIAN WAY APT 518
YULEE FL
32097-3407
US

V. Phone/Fax

Practice location:
  • Phone: 904-879-1223
  • Fax: 904-879-4986
Mailing address:
  • Phone: 904-716-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: