MEDICARE: CHRISTINE CREP PT, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6306	OTHER	MN	LICENSE #

General Provider Information

NPI Number	:	1033200738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CREP PT, CLT

Provider Business Mailing Address
First Line	:	4376 ARBRE LN N
Second Line	:
City	:	HUGO
State	:	MN
Zip	:	55038-4450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 COUNTY ROAD E E STE 120
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5191
Country	:	US
Telephone Number	:	651-241-1464
Fax Number	:	651-241-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	03/21/2017

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