Provider Demographics
NPI:1114214863
Name:FLAHERTY, CHRISTINE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRYSI
Other - Middle Name:CRICKET
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:755 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3331
Mailing Address - Country:US
Mailing Address - Phone:541-461-2238
Mailing Address - Fax:
Practice Address - Street 1:755 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3331
Practice Address - Country:US
Practice Address - Phone:541-461-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11043172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist