Provider Demographics
NPI:1093801706
Name:CHRISTY, JUDITH (CS PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:CS PRACTITIONER
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:CHRISTYMAQUEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:27451 435TH AVE
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1814
Mailing Address - Country:US
Mailing Address - Phone:218-820-0678
Mailing Address - Fax:
Practice Address - Street 1:27451 435TH AVE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1814
Practice Address - Country:US
Practice Address - Phone:218-820-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X, 374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN374T00000XOtherC S PRACTITIONER