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General NPI Number Information
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NPI Number | 1972036853
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Entity Type | Individual
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Provider Name | CHRISITNE R MICK 0131000159
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 8254 ATLEE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-1844
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Country | US
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Telephone | 804-342-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 KIEFER RD
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City | CHESTER
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State | VA
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Zip | 23831-1813
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Country | US
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Telephone | 804-748-4276
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 0131000159
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License Number State | VA
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