Provider Demographics
NPI:1659756039
Name:JORGENSEN, CHRISTINE (MAT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 POTEET DR APT 217
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7650
Mailing Address - Country:US
Mailing Address - Phone:469-585-6441
Mailing Address - Fax:
Practice Address - Street 1:3604 POTEET DR APT 217
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7650
Practice Address - Country:US
Practice Address - Phone:469-585-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT#44792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT#4479OtherSTATE OF TEXAS