Provider Demographics
NPI:1942481585
Name:CLAVERIA, CHRISSY C (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:C
Last Name:CLAVERIA
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:PO BOX 2393
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32644-2393
Mailing Address - Country:US
Mailing Address - Phone:352-493-1748
Mailing Address - Fax:
Practice Address - Street 1:609 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1106
Practice Address - Country:US
Practice Address - Phone:352-949-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33104172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1279OtherBLUE CROSS BLUE SHIELD