Healthcare Provider Details

I. General information

NPI: 1336417815
Provider Name (Legal Business Name): CHRISTY MARKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 BRADFORD PL
EXCELSIOR SPRINGS MO
64024-1679
US

IV. Provider business mailing address

2118 BRADFORD PL
EXCELSIOR SPRINGS MO
64024-1679
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-0401
  • Fax:
Mailing address:
  • Phone: 816-630-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2002005850
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: