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General NPI Number Information
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NPI Number | 1851911721
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Entity Type | Individual
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Provider Name | CRISTAN NICOLE CHINN PTA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 280 W 40TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-4664
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Country | US
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Telephone | 616-796-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 851 HARVARD DR
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City | HOLLAND
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State | MI
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Zip | 49423-3043
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Country | US
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Telephone | 269-240-1894
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502003849
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License Number State | MI
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