MEDICARE: CHRISTI MARIE THE PT, DPT

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	PT010205	GA

General Provider Information

NPI Number	:	1639497936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTI MARIE THE PT, DPT

Provider Business Mailing Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 105
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-623-0105
Fax Number	:	770-623-0602

Provider Business Practice Location Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 105
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-623-0105
Fax Number	:	770-623-0602

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

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	02/14/2012

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