Provider Demographics
NPI:1376131177
Name:HABERTHIER, CHRISTINE (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HABERTHIER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 25TH AVE NE APT V105
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-2902
Mailing Address - Country:US
Mailing Address - Phone:770-827-7503
Mailing Address - Fax:
Practice Address - Street 1:722 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2365
Practice Address - Country:US
Practice Address - Phone:770-827-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60924299225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty