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General NPI Number Information
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NPI Number | 1811753031
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Entity Type | Individual
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Provider Name | CHRISTINA NOEL REVILLE
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1041 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-1042
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Country | US
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Telephone | 207-699-4111
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Fax | 207-773-8814
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Provider Business Mailing Address
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Address Line | 5191 GLENDALE AVE
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City | HAMBURG
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State | NY
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Zip | 14075-5639
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Country | US
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Telephone | 716-698-8064
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT6674
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 050990
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P23275
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License Number State | NC
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