Provider Demographics
NPI:1518262005
Name:SPERRY, CRISTINA (CA PT LICENSE)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SPERRY
Suffix:
Gender:F
Credentials:CA PT LICENSE
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 801
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-0801
Mailing Address - Country:US
Mailing Address - Phone:707-678-2301
Mailing Address - Fax:
Practice Address - Street 1:1020 ALEXANDER CT
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-4108
Practice Address - Country:US
Practice Address - Phone:707-678-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist