Provider Demographics
NPI:1801210463
Name:WHITE, CHRISTINA AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:AUSTIN
Last Name:WHITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:AUSTIN
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-733-1200
Mailing Address - Fax:810-733-3130
Practice Address - Street 1:307 S COURT ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2514
Practice Address - Country:US
Practice Address - Phone:810-538-0600
Practice Address - Fax:810-538-0602
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B52045OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1801210463Medicaid
MI1801210463Medicaid