Provider Demographics
NPI:1659412393
Name:CHRISTOPHERSON, MARIE MAY (MSPT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MAY
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:BLDG 6, STE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4435
Practice Address - Country:US
Practice Address - Phone:757-874-0032
Practice Address - Fax:757-874-0127
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204918225100000X
DEJ1-0002129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7881903OtherAETNA
VA192948OtherBCBS (PHYSICAL THERAPY)
VA7881903OtherAETNA