Provider Demographics
NPI:1720048283
Name:CHRISTIE, CHERYL A (PT, AT,C, CSCS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PT, AT,C, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-0551
Mailing Address - Country:US
Mailing Address - Phone:631-327-1858
Mailing Address - Fax:
Practice Address - Street 1:1920 DEER PARK AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3324
Practice Address - Country:US
Practice Address - Phone:631-242-9200
Practice Address - Fax:631-242-9201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013622-12251X0800X
NY000618-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP6231Medicare ID - Type Unspecified