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General NPI Number Information
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NPI Number | 1316415961
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Entity Type | Individual
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Provider Name | CHRISTINA JONES WADE LMT
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Gender | Female
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 300 OFFICE PARK DR STE 205
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City | MOUNTAIN BRK
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State | AL
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Zip | 35223-2473
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Country | US
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Telephone | 205-678-1278
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 MAIN ST # 320
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City | GARDENDALE
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State | AL
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Zip | 35071-3484
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Country | US
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Telephone | 205-678-1278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5140
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License Number State | AL
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