Provider Demographics
NPI:1033604558
Name:CHRISTENSEN, JUSTINE DANIELLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:DANIELLE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S GOYER RD APT 70
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2742
Mailing Address - Country:US
Mailing Address - Phone:616-272-8388
Mailing Address - Fax:
Practice Address - Street 1:3431 N 400 W
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-9107
Practice Address - Country:US
Practice Address - Phone:616-272-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003010A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer