Provider Demographics
NPI:1629562376
Name:CHRISTY, CATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CHRISTIAN PETERSEN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:IA
Mailing Address - Zip Code:50105-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6301
Practice Address - Country:US
Practice Address - Phone:319-415-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty