Provider Demographics
NPI:1053319921
Name:MEASE, CHRISTINE DIANE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DIANE
Last Name:MEASE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CARLTON CT
Mailing Address - Street 2:
Mailing Address - City:THOROFARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 GROVE ST
Practice Address - Street 2:COOPER PHYSICAL THERAPY
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1224
Practice Address - Country:US
Practice Address - Phone:856-795-9330
Practice Address - Fax:856-854-7935
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA007131225100000X
PAPT009660L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-21170196OtherNJ CARPENTERS
NJ2356297000OtherAMERIHEALTH HMO
NJP3314980OtherOXFORD
NJ22-2170196OtherINTERGROUP
NJ22-2170196OtherDEVON
NJ1682858OtherAMERIHEALTH PPO
NJ1682858OtherPA BLUE SHIELD
NJ22-2170196OtherSIMCARE
NJ22-2170196OtherHORIZON BSNJ
NJ22-2170196OtherFIRST HEALTH
NJ222107019643OtherTRICARE/CHAMPUS
NJ222170196041OtherTRICARE/CHAMPUS
NJ22-2170196OtherLOCAL 825
NJ222170196041OtherTRICARE/CHAMPUS