Provider Demographics
NPI:1568622504
Name:ULSETH, CHRISTINE LYNNE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNNE
Last Name:ULSETH
Suffix:
Gender:F
Credentials:LMT
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 247
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-0247
Mailing Address - Country:US
Mailing Address - Phone:352-486-6899
Mailing Address - Fax:352-486-3865
Practice Address - Street 1:490 E HATHAWAY AVE
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6736
Practice Address - Country:US
Practice Address - Phone:352-486-6899
Practice Address - Fax:352-486-3865
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist