Provider Demographics
NPI:1528565231
Name:CASELLA, CHRISTINA M (LMT, LE, OM, MMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:CASELLA
Suffix:
Gender:F
Credentials:LMT, LE, OM, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N FRONT ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1766
Mailing Address - Country:US
Mailing Address - Phone:708-609-0292
Mailing Address - Fax:
Practice Address - Street 1:2021 N FRONT ST UNIT 308
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1766
Practice Address - Country:US
Practice Address - Phone:708-609-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227017932225700000X
PAMSG010641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist