Provider Demographics
NPI:1578786679
Name:FLETCHER, CHRISTINE L (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DPT
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 1299
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1299
Mailing Address - Country:US
Mailing Address - Phone:208-777-9740
Mailing Address - Fax:208-777-8316
Practice Address - Street 1:104 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9216
Practice Address - Country:US
Practice Address - Phone:208-777-9740
Practice Address - Fax:208-777-8316
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010803225100000X
IA04023225100000X
IDPT-2966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1578786679Medicaid
ID1578786679Medicaid