Provider Demographics
NPI:1578035986
Name:CHRISTIE, NISA (PT)
Entity Type:Individual
Prefix:
First Name:NISA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NISA
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-8019
Mailing Address - Country:US
Mailing Address - Phone:508-778-9336
Mailing Address - Fax:508-888-0165
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-771-6685
Practice Address - Fax:508-771-5774
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist