Healthcare Provider Details

I. General information

NPI: 1508989351
Provider Name (Legal Business Name): CHRISTIE FLETCHER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S OLD DIXIE HWY
JUPITER FL
33458-7200
US

IV. Provider business mailing address

304 MAPLECREST CIR
JUPITER FL
33458
US

V. Phone/Fax

Practice location:
  • Phone: 561-745-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: