Provider Demographics
NPI:1922081710
Name:BARANICK, CHRISTINE DRAGOO (PT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DRAGOO
Last Name:BARANICK
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 1:5122 CASA LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5122 CASA LOMA AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3943
Practice Address - Country:US
Practice Address - Phone:714-724-2575
Practice Address - Fax:714-993-9878
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27744EMedicare PIN