Healthcare Provider Details

I. General information

NPI: 1972973758
Provider Name (Legal Business Name): CHRISTINA ELISA BIDDLE MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 R C COOK RD APT 1
BLOWING ROCK NC
28605-9583
US

IV. Provider business mailing address

236 R C COOK RD APT 1
BLOWING ROCK NC
28605-9583
US

V. Phone/Fax

Practice location:
  • Phone: 540-550-5632
  • Fax:
Mailing address:
  • Phone: 540-550-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

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: