Provider Demographics
NPI:1548428709
Name:GEDATUS, CHRISTINE HELEN (MSPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HELEN
Last Name:GEDATUS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 SOLANO AVE
Mailing Address - Street 2:APT. 195
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2767
Mailing Address - Country:US
Mailing Address - Phone:443-540-9816
Mailing Address - Fax:
Practice Address - Street 1:3275 VILLA LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3016
Practice Address - Country:US
Practice Address - Phone:443-540-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist