Provider Demographics
NPI:1952849861
Name:CHRISTIE, CORNELIUS WELLS III (LMT, CR)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:WELLS
Last Name:CHRISTIE
Suffix:III
Gender:M
Credentials:LMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 METROPOLITAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5779
Mailing Address - Country:US
Mailing Address - Phone:315-430-0122
Mailing Address - Fax:
Practice Address - Street 1:106 METROPOLITAN PARK DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5779
Practice Address - Country:US
Practice Address - Phone:315-430-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018350225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist