Provider Demographics
NPI:1538697057
Name:GEPFERT, CHRISTINE A (LMBT, RYT, PMA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:GEPFERT
Suffix:
Gender:F
Credentials:LMBT, RYT, PMA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:G
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19508 FERIBA PL
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8100
Mailing Address - Country:US
Mailing Address - Phone:704-607-3343
Mailing Address - Fax:
Practice Address - Street 1:19900 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6513
Practice Address - Country:US
Practice Address - Phone:704-607-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5618224Y00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist