Provider Demographics
NPI:1699824292
Name:KUDABECK, CHRISTINA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:KUDABECK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:ANTONGIOVANNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:6913 57TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4901
Mailing Address - Country:US
Mailing Address - Phone:253-848-6844
Mailing Address - Fax:
Practice Address - Street 1:1503 W STEWART
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5149
Practice Address - Country:US
Practice Address - Phone:253-848-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA36080OtherDEPT OF LABOR &INDUSTRIES