Healthcare Provider Details

I. General information

NPI: 1811415706
Provider Name (Legal Business Name): CHRISTI HRAB RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51596 STATE ROAD 933
SOUTH BEND IN
46637-1704
US

IV. Provider business mailing address

51596 STATE ROAD 933
SOUTH BEND IN
46637-1704
US

V. Phone/Fax

Practice location:
  • Phone: 574-367-8580
  • Fax: 630-206-2439
Mailing address:
  • Phone: 574-367-8580
  • Fax: 630-206-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30005562A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: