Healthcare Provider Details

I. General information

NPI: 1114566346
Provider Name (Legal Business Name): CHRISTINA ANN OVERGAARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S INDUSTRIAL HWY
ANN ARBOR MI
48104-6796
US

IV. Provider business mailing address

5772 SUNRISE DR
YPSILANTI MI
48197-7505
US

V. Phone/Fax

Practice location:
  • Phone: 800-842-5504
  • Fax:
Mailing address:
  • Phone: 734-395-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: