Provider Demographics
NPI:1508188137
Name:TAYLOR, CHRISTINA VICTORIA (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:VICTORIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NE D ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2379
Mailing Address - Country:US
Mailing Address - Phone:541-324-6038
Mailing Address - Fax:888-474-1037
Practice Address - Street 1:815 NE D ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2379
Practice Address - Country:US
Practice Address - Phone:541-324-6038
Practice Address - Fax:888-474-1037
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist