Provider Demographics
NPI:1346426707
Name:LILLARD, CHRISTINA NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:LILLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 N MONTE VISTA ST
Mailing Address - Street 2:THE PERFORMANCE CENTER, PLLC
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4611
Mailing Address - Country:US
Mailing Address - Phone:580-436-3633
Mailing Address - Fax:580-436-2977
Practice Address - Street 1:511 N MONTE VISTA ST
Practice Address - Street 2:THE PERFORMANCE CENTER, PLLC
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4611
Practice Address - Country:US
Practice Address - Phone:580-436-3633
Practice Address - Fax:580-436-2977
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist