Provider Demographics
NPI:1114943560
Name:DRAKE, CRISTINE EALENA (DPT;LMT)
Entity Type:Individual
Prefix:DR
First Name:CRISTINE
Middle Name:EALENA
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DPT;LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 25TH CT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9332
Mailing Address - Country:US
Mailing Address - Phone:561-762-7468
Mailing Address - Fax:
Practice Address - Street 1:10800 N MILITARY TRL STE 111
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6527
Practice Address - Country:US
Practice Address - Phone:561-775-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48609225700000X
FLPT27909225100000X
226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist