Provider Demographics
NPI:1275239550
Name:LANNIE, CHRISTIAN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:LANNIE
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 1:515 WILL COMBS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VILAS
Mailing Address - State:NC
Mailing Address - Zip Code:28692
Mailing Address - Country:US
Mailing Address - Phone:336-682-7492
Mailing Address - Fax:
Practice Address - Street 1:515 WILL COMBS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:VILAS
Practice Address - State:NC
Practice Address - Zip Code:28692
Practice Address - Country:US
Practice Address - Phone:336-682-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist