Provider Demographics
NPI:1275225740
Name:DEMAREE, CHRISTOPHER HAYDEN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HAYDEN
Last Name:DEMAREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 BLUE AGAVE LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2329
Mailing Address - Country:US
Mailing Address - Phone:325-347-7519
Mailing Address - Fax:
Practice Address - Street 1:1734 N MAYS ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2915
Practice Address - Country:US
Practice Address - Phone:325-347-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT137396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist