Provider Demographics
NPI:1356378632
Name:PLYMAL, CHRISTIE SHANTELL, YATES (MPT, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:SHANTELL, YATES
Last Name:PLYMAL
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 PLAZA DR # H
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-9434
Mailing Address - Country:US
Mailing Address - Phone:276-935-5525
Mailing Address - Fax:276-935-5523
Practice Address - Street 1:1103 PLAZA DR # H
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-9434
Practice Address - Country:US
Practice Address - Phone:276-935-5525
Practice Address - Fax:276-935-5523
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2000X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000838Medicaid
WV3810000838Medicaid