Provider Demographics
NPI:1275764052
Name:STAVRES, CHRISTIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:STAVRES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8241 GREENMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8658
Mailing Address - Country:US
Mailing Address - Phone:850-942-6949
Mailing Address - Fax:
Practice Address - Street 1:8241 GREENMONT AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-8658
Practice Address - Country:US
Practice Address - Phone:850-942-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist