Provider Demographics
NPI:1841402310
Name:SAN ANTONIO, CHRISTINE (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:SAN ANTONIO
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 1:350 LINCOLN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1578
Mailing Address - Country:US
Mailing Address - Phone:781-740-4900
Mailing Address - Fax:781-740-4930
Practice Address - Street 1:350 LINCOLN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1578
Practice Address - Country:US
Practice Address - Phone:781-740-4900
Practice Address - Fax:781-740-4930
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68296OtherBCBS
MA0325783Medicaid
MA2179597OtherFIRST HEALTH
MA5510520OtherCCN
MA7255570OtherAETNA
MAY69311Medicare ID - Type Unspecified