Provider Demographics
NPI:1770045817
Name:O'MALLEY, CHRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:O'MALLEY
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 1:4168 ROCKY RIVER DR STE 5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-6100
Mailing Address - Country:US
Mailing Address - Phone:216-671-6080
Mailing Address - Fax:216-671-6184
Practice Address - Street 1:4168 ROCKY RIVER DR STE 5
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-6100
Practice Address - Country:US
Practice Address - Phone:216-671-6080
Practice Address - Fax:216-671-6184
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020857225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist