Provider Demographics
NPI:1588610810
Name:CHRISTIAN, MICHAEL HAROLD (RKT, DRS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HAROLD
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:RKT, DRS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:312 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:IA
Mailing Address - Zip Code:50256-8550
Mailing Address - Country:US
Mailing Address - Phone:641-842-3101
Mailing Address - Fax:641-828-6796
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3354
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:641-828-6796
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA1257226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist