Provider Demographics
NPI:1831114693
Name:GOMEZ, CHRISTINE ANN-ROOT (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN-ROOT
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-9599
Mailing Address - Country:US
Mailing Address - Phone:269-382-2284
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1701
Practice Address - Country:US
Practice Address - Phone:269-792-4410
Practice Address - Fax:269-792-4538
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant