Healthcare Provider Details

I. General information

NPI: 1770564767
Provider Name (Legal Business Name): CHRISTINA MARIE KELLEIGH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE PUTNEY MPT

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 WRIGHTSVILLE AVE STE 120
WILMINGTON NC
28403-6256
US

IV. Provider business mailing address

PO BOX 412313
BOSTON MA
02241-2313
US

V. Phone/Fax

Practice location:
  • Phone: 910-679-8385
  • Fax: 910-679-8387
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11549
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number11549
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: