Provider Demographics
NPI:1174852602
Name:RACKLEY, CHRISTINE ALLISON (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALLISON
Last Name:RACKLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CASS
Other - Middle Name:A
Other - Last Name:RACKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:5926 SHADY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9333
Mailing Address - Country:US
Mailing Address - Phone:541-941-4937
Mailing Address - Fax:541-772-5939
Practice Address - Street 1:832 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7153
Practice Address - Country:US
Practice Address - Phone:541-772-5939
Practice Address - Fax:541-772-5939
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist