Provider Demographics
NPI:1023243920
Name:STUDEBAKER, CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:STUDEBAKER
Suffix:
Gender:F
Credentials:PTA
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 373
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-0373
Mailing Address - Country:US
Mailing Address - Phone:309-830-9857
Mailing Address - Fax:
Practice Address - Street 1:132 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-4363
Practice Address - Country:US
Practice Address - Phone:309-830-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106.004408225200000X
AR1755225200000X
FL20310225200000X
MO2006032149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant