Provider Demographics
NPI:1144757808
Name:DIMICHELE, CHRISTINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DIMICHELE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N 3RD ST
Mailing Address - Street 2:APT 217
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1573
Mailing Address - Country:US
Mailing Address - Phone:610-304-2042
Mailing Address - Fax:
Practice Address - Street 1:1151 N 3RD ST
Practice Address - Street 2:APT 217
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1573
Practice Address - Country:US
Practice Address - Phone:610-304-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023875225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist