Provider Demographics
NPI:1073954830
Name:GAVE, CHRISTINE (LPTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GAVE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46062 OAKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5337
Mailing Address - Country:US
Mailing Address - Phone:586-567-1982
Mailing Address - Fax:
Practice Address - Street 1:38777 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2694
Practice Address - Country:US
Practice Address - Phone:888-414-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001238225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant