Provider Demographics
NPI:1083034094
Name:DONALDSON, CHRISTINE DIANE (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:DIANE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16915 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3620
Mailing Address - Country:US
Mailing Address - Phone:216-227-2610
Mailing Address - Fax:216-227-2614
Practice Address - Street 1:16915 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3620
Practice Address - Country:US
Practice Address - Phone:216-227-2610
Practice Address - Fax:216-227-2614
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04366OtherPHYSICAL THERAPY LICENSE NUMBER