Provider Demographics
NPI:1255706909
Name:HITCHCOCK, CHRISTINA RENEA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENEA
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 CASEY RD
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8893
Mailing Address - Country:US
Mailing Address - Phone:775-217-0876
Mailing Address - Fax:
Practice Address - Street 1:67 WHITAKER LN
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3142
Practice Address - Country:US
Practice Address - Phone:775-217-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.7590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist