Provider Demographics
NPI:1609139815
Name:SEGAN, CHRISTINA L (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:SEGAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 PINE TREE DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2841
Mailing Address - Country:US
Mailing Address - Phone:360-340-8738
Mailing Address - Fax:
Practice Address - Street 1:1050 HILDEBRAND LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2863
Practice Address - Country:US
Practice Address - Phone:206-842-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60269475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist