Provider Demographics
NPI:1003393851
Name:CALDWELL, CHRISTIE ANNETTE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ANNETTE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2200 WATERLOO PL
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-5823
Mailing Address - Country:US
Mailing Address - Phone:903-267-4499
Mailing Address - Fax:
Practice Address - Street 1:2200 WATERLOO PL
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-5823
Practice Address - Country:US
Practice Address - Phone:903-267-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist