Provider Demographics
NPI:1609900968
Name:SHENK, CHRISTINE ANDREWS (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANDREWS
Last Name:SHENK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 MARATHON CIRCLE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-0000
Mailing Address - Country:US
Mailing Address - Phone:678-945-8525
Mailing Address - Fax:
Practice Address - Street 1:3762 MARATHON CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1143
Practice Address - Country:US
Practice Address - Phone:678-945-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1883225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant