Provider Demographics
NPI:1780937037
Name:PIERPONT, CHRISTINE (DPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:PIERPONT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MAZZUCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:6842 RACE TRACK RD STE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3011
Practice Address - Country:US
Practice Address - Phone:240-544-0200
Practice Address - Fax:301-464-1053
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033573-1225100000X
MD26447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist