Provider Demographics
NPI:1235307570
Name:GASSTROM, CHRISTINE RIZZO (MS LAC CH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RIZZO
Last Name:GASSTROM
Suffix:
Gender:F
Credentials:MS LAC CH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LAC CH
Mailing Address - Street 1:27 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2216
Mailing Address - Country:US
Mailing Address - Phone:860-961-5560
Mailing Address - Fax:
Practice Address - Street 1:955 S MAIN ST STE B201
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5153
Practice Address - Country:US
Practice Address - Phone:860-961-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist