Provider Demographics
NPI:1255005187
Name:DEAN, CHRISTINE HOPE LATAINE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HOPE LATAINE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 LOG CABIN RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8511
Mailing Address - Country:US
Mailing Address - Phone:336-964-9470
Mailing Address - Fax:
Practice Address - Street 1:503 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4728
Practice Address - Country:US
Practice Address - Phone:336-626-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA47312081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA4731OtherPHYSICAL THERAPIST ASSISTANT