Healthcare Provider Details

I. General information

NPI: 1033200738
Provider Name (Legal Business Name): CHRISTINE CREP PT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 COUNTY ROAD E E STE 120
VADNAIS HEIGHTS MN
55110-5191
US

IV. Provider business mailing address

4376 ARBRE LN N
HUGO MN
55038-4450
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-1464
  • Fax: 651-241-1451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: