Provider Demographics
NPI:1164645370
Name:WOJTKOWSKI, CHRISTY A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:A
Last Name:WOJTKOWSKI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5507
Mailing Address - Country:US
Mailing Address - Phone:479-495-6326
Mailing Address - Fax:479-495-3336
Practice Address - Street 1:714 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-6326
Practice Address - Fax:479-495-3336
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y274OtherBLUE CROSS ID NUMBER
ARPT1613OtherSTATE LICENSE NUMBER