Healthcare Provider Details

I. General information

NPI: 1508157496
Provider Name (Legal Business Name): CHRISTINE DEERIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 N SHERMAN STREET EXT
MOUNT WOLF PA
17347-9637
US

IV. Provider business mailing address

4880 N SHERMAN STREET EXT
MOUNT WOLF PA
17347-9637
US

V. Phone/Fax

Practice location:
  • Phone: 717-266-9294
  • Fax: 717-384-8071
Mailing address:
  • Phone: 717-266-9294
  • Fax: 717-384-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE008770
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: