Provider Demographics
NPI:1275662926
Name:CHANCE, CHRISTINA ELLEN (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELLEN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 60TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7039
Mailing Address - Country:US
Mailing Address - Phone:360-753-6617
Mailing Address - Fax:
Practice Address - Street 1:2415 EVERGREEN PARK DR SW STE C4
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6007
Practice Address - Country:US
Practice Address - Phone:360-878-2246
Practice Address - Fax:360-515-0767
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist