MEDICARE: MRS. CHRISTINA LOUISE WEISS A.T.,C.

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1851425946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA LOUISE WEISS A.T.,C.

Provider Business Mailing Address
First Line	:	47950 SANDY RIDGE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-5921
Country	:	US
Telephone Number	:	248-964-0218
Fax Number	:	248-964-0220

Provider Business Practice Location Address
First Line	:	44300 DEQUINDRE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1003
Country	:	US
Telephone Number	:	248-964-0200
Fax Number	:	248-694-0220

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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