Provider Demographics
NPI:1982645743
Name:MUMMELTHEY, CHRISTIANE M (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:M
Last Name:MUMMELTHEY
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:PO BOX 23417
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70183-0417
Mailing Address - Country:US
Mailing Address - Phone:504-818-1365
Mailing Address - Fax:504-818-1363
Practice Address - Street 1:1 STOREHOUSE LN
Practice Address - Street 2:SUITE C
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3826
Practice Address - Country:US
Practice Address - Phone:985-764-5022
Practice Address - Fax:985-764-5032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT982251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CM80Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER