Provider Demographics
NPI:1518182930
Name:POWELL, CHRISTINE CAROLYN (PT, MED)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:CAROLYN
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7221
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7221
Mailing Address - Country:US
Mailing Address - Phone:949-597-0007
Mailing Address - Fax:
Practice Address - Street 1:23521 PASEO DE VALENCIA 210
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3140
Practice Address - Country:US
Practice Address - Phone:949-597-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518182930OtherNPI