Healthcare Provider Details

I. General information

NPI: 1194845909
Provider Name (Legal Business Name): CHRISTINA DEANNE HOWARD MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RIVER RD STE 102 AXIS PHYSICAL THERAPY & REHAB INC
EUGENE OR
97404
US

IV. Provider business mailing address

1859 JEFFERSON STREET
EUGENE OR
97402
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-6187
  • Fax: 541-689-4529
Mailing address:
  • Phone: 541-684-4542
  • Fax: 541-689-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3891
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier181410
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: