Provider Demographics
NPI:1073533055
Name:AKSAMIT, CHRISTINA (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:AKSAMIT
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:PO BOX 52190
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-2190
Mailing Address - Country:US
Mailing Address - Phone:307-472-3327
Mailing Address - Fax:307-472-0297
Practice Address - Street 1:455 THELMA DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2324
Practice Address - Country:US
Practice Address - Phone:307-472-3327
Practice Address - Fax:307-472-0297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34191225100000X
WYPT-0912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400618Medicaid
MT000050706Medicare ID - Type Unspecified