Provider Demographics
NPI:1750364667
Name:LONGOBUCCO, CHRISTINA MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:LONGOBUCCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 BELFORT RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1409
Mailing Address - Country:US
Mailing Address - Phone:904-296-3711
Mailing Address - Fax:904-296-4088
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-296-3711
Practice Address - Fax:904-296-4088
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY035UOtherBLUECROSS/BLUESHIELD
FLP00049736OtherRAILROAD MEDICARE
FLY035UOtherBLUECROSS/BLUESHIELD