Provider Demographics
NPI:1942867924
Name:BARBARA, CHRISTINE C (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:C
Last Name:BARBARA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:C
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:53 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4003
Mailing Address - Country:US
Mailing Address - Phone:917-974-2626
Mailing Address - Fax:
Practice Address - Street 1:53 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4003
Practice Address - Country:US
Practice Address - Phone:917-974-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001069-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer