Healthcare Provider Details

I. General information

NPI: 1013120872
Provider Name (Legal Business Name): CHRISTINE MARIE CHURCHILL LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 W RAMSEY AVE
MILWAUKEE WI
53221-4814
US

IV. Provider business mailing address

5708 S MADELINE AVE
MILWAUKEE WI
53221-3950
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-2600
  • Fax: 414-282-2051
Mailing address:
  • Phone: 414-423-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number557-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: