Provider Demographics
NPI:1871679274
Name:HERZIG, CHRISTINE DEVERE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DEVERE
Last Name:HERZIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7542 RAINSWEPT LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1362
Mailing Address - Country:US
Mailing Address - Phone:619-589-1338
Mailing Address - Fax:
Practice Address - Street 1:5897 OBERLIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3761
Practice Address - Country:US
Practice Address - Phone:858-455-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1106Medicare UPIN