Provider Demographics
NPI:1417021809
Name:FISH, CHRISTA (MMP, NCMT, RYT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:MMP, NCMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11115 GREAT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3159
Mailing Address - Country:US
Mailing Address - Phone:804-550-7760
Mailing Address - Fax:
Practice Address - Street 1:2927A W CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-3515
Practice Address - Country:US
Practice Address - Phone:804-986-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019002004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist