Provider Demographics
NPI:1760625933
Name:CHRISTOPHERSEN, MARICHU DE GUIA (DPT)
Entity Type:Individual
Prefix:
First Name:MARICHU
Middle Name:DE GUIA
Last Name:CHRISTOPHERSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARICHU
Other - Middle Name:DE GUIA
Other - Last Name:EAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3562 WOODWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783
Mailing Address - Country:US
Mailing Address - Phone:702-299-5424
Mailing Address - Fax:
Practice Address - Street 1:3562 WOODWARD AVENUE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783
Practice Address - Country:US
Practice Address - Phone:702-299-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300982251G0304X, 2251P0200X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic