Provider Demographics
NPI:1780063008
Name:CHRISTIAN, MCCALL (DAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MCCALL
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 S MAIN AVE APT G303
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-7848
Mailing Address - Country:US
Mailing Address - Phone:816-835-3771
Mailing Address - Fax:
Practice Address - Street 1:901 S NATIONAL AVE # 160
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-4351
Practice Address - Country:US
Practice Address - Phone:417-836-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer