Provider Demographics
NPI:1013166149
Name:LICATA, CHRISTINE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:LICATA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SPRINGDALE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2858
Mailing Address - Country:US
Mailing Address - Phone:484-874-2130
Mailing Address - Fax:484-874-2129
Practice Address - Street 1:855 SPRINGDALE DR STE 110
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2858
Practice Address - Country:US
Practice Address - Phone:484-874-2130
Practice Address - Fax:484-874-2129
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017514225100000X
PADAPT003062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859173Medicare PIN
IL202845034Medicare PIN
ILP01369588Medicare PIN
PA371047VKFMedicare PIN
IL211585010Medicare PIN