Provider Demographics
NPI:1629349899
Name:RAGAN, CHRISTINE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DAWN
Last Name:RAGAN
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 1:4545 WESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5937
Mailing Address - Country:US
Mailing Address - Phone:321-480-6208
Mailing Address - Fax:
Practice Address - Street 1:4545 WESTVIEW LN
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5937
Practice Address - Country:US
Practice Address - Phone:321-480-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18775225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant