Provider Demographics
NPI:1619687092
Name:TEEPLE, CHRISTA J
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:J
Last Name:TEEPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 BELLMAWR LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5106
Mailing Address - Country:US
Mailing Address - Phone:260-705-3449
Mailing Address - Fax:
Practice Address - Street 1:605 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1850
Practice Address - Country:US
Practice Address - Phone:260-705-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902610D225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist