Provider Demographics
NPI:1992002109
Name:KING, CHRISTINE EILEEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:EILEEN
Last Name:KING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:EILEEN
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:866 68TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5708
Mailing Address - Country:US
Mailing Address - Phone:917-374-0299
Mailing Address - Fax:
Practice Address - Street 1:866 68TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5708
Practice Address - Country:US
Practice Address - Phone:917-374-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist