Provider Demographics
NPI:1750024758
Name:MACKLIN, CHRISTIAN (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3564
Mailing Address - Country:US
Mailing Address - Phone:216-773-1546
Mailing Address - Fax:
Practice Address - Street 1:7220 BAILLIE DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-4914
Practice Address - Country:US
Practice Address - Phone:844-325-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant