Provider Demographics
NPI:1114593969
Name:STRAUTHER, CHRISTA NICOLE
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:NICOLE
Last Name:STRAUTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58782 MEADOW CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2115
Mailing Address - Country:US
Mailing Address - Phone:248-252-8882
Mailing Address - Fax:
Practice Address - Street 1:58782 MEADOW CREEK BLVD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48048-2115
Practice Address - Country:US
Practice Address - Phone:248-252-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501005622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist