Provider Demographics
NPI:1609349141
Name:ST. AMOUR, CHRISTIE (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:ST. AMOUR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1703 W STONES CROSSING RD STE 120
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8558
Practice Address - Country:US
Practice Address - Phone:317-528-2018
Practice Address - Fax:317-528-2907
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IN05013092A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist