Provider Demographics
NPI:1790289866
Name:EBRIGHT, CHRISTINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:EBRIGHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 ELM COUNT
Mailing Address - Street 2:STE 206
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4303
Mailing Address - Country:US
Mailing Address - Phone:573-681-0447
Mailing Address - Fax:573-681-0445
Practice Address - Street 1:1447 N HARRISON ST # 48602
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023653225100000X
MI5501016417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist