Provider Demographics
NPI:1942430558
Name:DESIMONE, CHRISTIE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WEST FM 407
Mailing Address - Street 2:SUITE 201-337
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2183
Mailing Address - Country:US
Mailing Address - Phone:214-998-8222
Mailing Address - Fax:
Practice Address - Street 1:2653 SAGEBRUSH DR
Practice Address - Street 2:SUITE 230
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2733
Practice Address - Country:US
Practice Address - Phone:214-998-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist