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General NPI Number Information
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NPI Number | 1417021809
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Entity Type | Individual
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Provider Name | CHRISTA FISH MMP, NCMT, RYT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2927A W CARY ST
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City | RICHMOND
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State | VA
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Zip | 23221-3515
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Country | US
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Telephone | 804-986-1723
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Fax |
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Provider Business Mailing Address
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Address Line | 11115 GREAT MEADOWS DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-3159
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Country | US
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Telephone | 804-550-7760
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0019002004
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License Number State | VA
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