Provider Demographics
NPI:1396065579
Name:MCNAIL, CHRISTINA DEANN (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DEANN
Last Name:MCNAIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DEANN
Other - Last Name:IMGARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-6082
Mailing Address - Fax:573-449-0401
Practice Address - Street 1:2902 FORUM BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5404
Practice Address - Country:US
Practice Address - Phone:573-442-5268
Practice Address - Fax:573-442-5278
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070346922255A2300X
MO2010017704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL35000016Medicare PIN
MO991521003Medicare PIN