Provider Demographics
NPI:1790175347
Name:EDWARDS, CHRISTINE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:ZABIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:114 MAPLEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-1633
Mailing Address - Country:US
Mailing Address - Phone:413-575-1442
Mailing Address - Fax:
Practice Address - Street 1:136 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2324
Practice Address - Country:US
Practice Address - Phone:413-788-2171
Practice Address - Fax:413-788-2173
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2211225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant