Provider Demographics
NPI:1457574410
Name:BACH, CRISTINA ELIZABETH (MPT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:BACH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4497 STATE ROUTE 164
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9614
Mailing Address - Country:US
Mailing Address - Phone:303-303-5730
Mailing Address - Fax:
Practice Address - Street 1:648 LONGHORN ST NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9469
Practice Address - Country:US
Practice Address - Phone:330-303-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist