MEDICARE: CHRISTINA ELIZABETH EDMONDS

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	225700000X	Massage Therapist	033249-01	NY

General Provider Information

NPI Number	:	1689568909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ELIZABETH EDMONDS

Provider Business Mailing Address
First Line	:	632 E 228TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3802
Country	:	US
Telephone Number	:	646-323-1276
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 E 228TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3802
Country	:	US
Telephone Number	:	646-323-1276
Fax Number	:

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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