Provider Demographics
NPI:1679760078
Name:MCCHRISTIAN, CHRISTINA LYNN (MT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:MCCHRISTIAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST STE 145
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3055
Mailing Address - Country:US
Mailing Address - Phone:207-710-3000
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST STE 145
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3055
Practice Address - Country:US
Practice Address - Phone:207-710-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT 1677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist