Provider Demographics
NPI:1528037884
Name:KELLOGG, CHRISTINE CLAIRE (PT, DOM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CLAIRE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:PT, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 BAYWATER DR
Mailing Address - Street 2:TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3519
Mailing Address - Country:US
Mailing Address - Phone:850-294-0554
Mailing Address - Fax:
Practice Address - Street 1:3001 N ROCKY POINT DR E
Practice Address - Street 2:SUITE 185
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5810
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1643171100000X
FLPT14546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist