Provider Demographics
NPI:1427189646
Name:BEHRENS, CHRISTINA L
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:L
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MORRISON RD
Mailing Address - Street 2:STE 205
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5324
Mailing Address - Country:US
Mailing Address - Phone:614-755-2347
Mailing Address - Fax:614-755-2348
Practice Address - Street 1:670 MORRISON RD
Practice Address - Street 2:STE 205
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5324
Practice Address - Country:US
Practice Address - Phone:614-755-2347
Practice Address - Fax:614-755-2348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-01-18
Deactivation Date:2013-04-18
Deactivation Code:
Reactivation Date:2020-11-19
Provider Licenses
StateLicense IDTaxonomies
OH12637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2533100Medicaid