Provider Demographics
NPI:1316415961
Name:WADE, CHRISTINA JONES (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JONES
Last Name:WADE
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 1:1034 MAIN ST # 320
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3484
Mailing Address - Country:US
Mailing Address - Phone:205-678-1278
Mailing Address - Fax:
Practice Address - Street 1:300 OFFICE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2473
Practice Address - Country:US
Practice Address - Phone:205-678-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty