Provider Demographics
NPI:1770564767
Name:KELLEIGH, CHRISTINA MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KELLEIGH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:PUTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1519 PORTSMOUTH PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9251
Mailing Address - Country:US
Mailing Address - Phone:910-899-2537
Mailing Address - Fax:
Practice Address - Street 1:3901 WRIGHTSVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6256
Practice Address - Country:US
Practice Address - Phone:910-679-8385
Practice Address - Fax:910-679-8387
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115492251P0200X, 225100000X
225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
7384345OtherAETNA
4980093OtherVIRGINIA PREMIER HEALTH
VA35062OtherOPTIMA
11230494OtherCAQH
NC223302OtherMEDCOST
NC870146OtherUNITED HEALTHCARE/OPTUM HEALTH
436752OtherANTHEM BLUE CROSS
VA9116460OtherMEDICAID DME
NC0682UOtherBCBS NC
VA6400313OtherUNITED HEALTHCARE
VA9116460OtherMEDICAID DME
NC870146OtherUNITED HEALTHCARE/OPTUM HEALTH
NC1770564767OtherTRICARE
VA6400313OtherUNITED HEALTHCARE
7384345OtherAETNA