Healthcare Provider Details

I. General information

NPI: 1417079278
Provider Name (Legal Business Name): CHRISTINE LYN IRWIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LYELL AVE STE 102
ROCHESTER NY
14606-5743
US

IV. Provider business mailing address

210 CLIFTON SPRINGS PROFESSIONAL PARK
CLIFTON SPRINGS NY
14432-1041
US

V. Phone/Fax

Practice location:
  • Phone: 585-426-3041
  • Fax: 585-426-4031
Mailing address:
  • Phone: 153-462-3588
  • Fax: 315-906-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11024
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: