Provider Demographics
NPI:1851425946
Name:WEISS, CHRISTINA LOUISE (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:WEISS
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KINZEY-WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT,C
Mailing Address - Street 1:47950 SANDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5921
Mailing Address - Country:US
Mailing Address - Phone:248-964-0218
Mailing Address - Fax:248-964-0220
Practice Address - Street 1:44300 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1003
Practice Address - Country:US
Practice Address - Phone:248-964-0200
Practice Address - Fax:248-694-0220
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer