Provider Demographics
NPI:1710246624
Name:MONDAINE, CHRISTANNA J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTANNA
Middle Name:J
Last Name:MONDAINE
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 1:3905 BLANCHE LN NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3292
Mailing Address - Country:US
Mailing Address - Phone:503-309-1810
Mailing Address - Fax:
Practice Address - Street 1:3905 BLANCHE LN NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-3292
Practice Address - Country:US
Practice Address - Phone:503-309-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist