Provider Demographics
NPI:1841234812
Name:MCCULLOUGH, CHRISTINA GEORGELAS (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:GEORGELAS
Last Name:MCCULLOUGH
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Gender:F
Credentials:PT, MS
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Mailing Address - Street 1:2845 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4574
Mailing Address - Country:US
Mailing Address - Phone:972-378-6868
Mailing Address - Fax:214-279-0738
Practice Address - Street 1:2845 PARKWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4574
Practice Address - Country:US
Practice Address - Phone:972-378-6868
Practice Address - Fax:214-279-0738
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1157015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0083Medicare PIN