Provider Demographics
NPI:1821598533
Name:MERRILL, CHRISTINE ANN (LMT NCBTMB)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LMT NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CHEROKEE DRAW RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-4066
Mailing Address - Country:US
Mailing Address - Phone:630-750-6238
Mailing Address - Fax:512-828-7441
Practice Address - Street 1:5701 CHEROKEE DRAW RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-4066
Practice Address - Country:US
Practice Address - Phone:630-750-6238
Practice Address - Fax:512-828-7441
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT120234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist