Provider Demographics
NPI:1023420981
Name:MOCKABEE, CHRISTINA TALARZYK (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:TALARZYK
Last Name:MOCKABEE
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 1:3254 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1561
Mailing Address - Country:US
Mailing Address - Phone:614-975-2474
Mailing Address - Fax:
Practice Address - Street 1:3254 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1561
Practice Address - Country:US
Practice Address - Phone:614-975-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist