Provider Demographics
NPI:1457638090
Name:CHRISTENSEN, ANTHONY BLAINE (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BLAINE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1807
Mailing Address - Country:US
Mailing Address - Phone:229-336-8255
Mailing Address - Fax:229-336-1932
Practice Address - Street 1:99 E BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1807
Practice Address - Country:US
Practice Address - Phone:229-336-8255
Practice Address - Fax:229-336-1932
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT010096OtherLICENSE