Provider Demographics
NPI:1245922566
Name:PEABODY, CHRISTY M
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:PEABODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 RIDGE RD STE 100202
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5650
Mailing Address - Country:US
Mailing Address - Phone:440-882-6382
Mailing Address - Fax:440-882-6391
Practice Address - Street 1:6900 RIDGE RD STE 100202
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5650
Practice Address - Country:US
Practice Address - Phone:440-882-6382
Practice Address - Fax:440-882-6391
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.010112225700000X
224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist