Provider Demographics
NPI:1467643429
Name:AMUNDSON, CHRISTIE JANE THAMES (PT, DPT, PRC, HFS)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:JANE THAMES
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:PT, DPT, PRC, HFS
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:JANE
Other - Last Name:THAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PRC, HFS
Mailing Address - Street 1:1600 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3898
Mailing Address - Country:US
Mailing Address - Phone:651-999-1029
Mailing Address - Fax:651-641-0726
Practice Address - Street 1:1600 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 10
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3898
Practice Address - Country:US
Practice Address - Phone:651-999-1029
Practice Address - Fax:651-641-0726
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist