Provider Demographics
NPI:1003266537
Name:MARRON, CHRISTIANA
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:MARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E BROWARD BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2020
Mailing Address - Country:US
Mailing Address - Phone:845-629-6122
Mailing Address - Fax:954-999-0116
Practice Address - Street 1:800 E BROWARD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2020
Practice Address - Country:US
Practice Address - Phone:845-629-6122
Practice Address - Fax:954-999-0116
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31525225100000X, 2251X0800X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31525OtherCASH PAY PRACTICE