Provider Demographics
NPI:1184752313
Name:EVERETT, CHRISTINE A (ATC LAT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:EVERETT
Suffix:
Gender:F
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 WILLOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2799
Mailing Address - Country:US
Mailing Address - Phone:407-509-0751
Mailing Address - Fax:
Practice Address - Street 1:6100 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3437
Practice Address - Country:US
Practice Address - Phone:407-482-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer