Provider Demographics
NPI:1124377510
Name:BEMIS, CHRISTY ANN ELAINE (MS LMT NCBTMB)
Entity Type:Individual
Prefix:
First Name:CHRISTY ANN
Middle Name:ELAINE
Last Name:BEMIS
Suffix:
Gender:F
Credentials:MS LMT NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WI
Mailing Address - Zip Code:53559-9377
Mailing Address - Country:US
Mailing Address - Phone:608-655-1875
Mailing Address - Fax:
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:WI
Practice Address - Zip Code:53559-9377
Practice Address - Country:US
Practice Address - Phone:608-655-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10595-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist