Provider Demographics
NPI:1790879948
Name:PEARSON, CHRISTINE A (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 COON RAPIDS BLVD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5641
Mailing Address - Country:US
Mailing Address - Phone:763-786-6900
Mailing Address - Fax:
Practice Address - Street 1:320 COON RAPIDS BLVD NW STE 200
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5641
Practice Address - Country:US
Practice Address - Phone:763-786-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP19822OtherHEALTHPARTNERS
MN58796OtherAMERICA'S PPO
MN6405085OtherMEDICA
MN60D51PEOtherBCBS OF MN
MN650000516Medicare ID - Type UnspecifiedWPS MEDICARE