Healthcare Provider Details

I. General information

NPI: 1487051355
Provider Name (Legal Business Name): CHRISTINE ARMANTROUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W MAIN ST
COLE CAMP MO
65325-1144
US

IV. Provider business mailing address

3105 BLUFF CREEK DR
COLUMBIA MO
65201
US

V. Phone/Fax

Practice location:
  • Phone: 660-668-0119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2007035729
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: