Provider Demographics
NPI:1841550514
Name:WILLE, CHRISTINA M (LMT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:WILLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9629 CLIPKNOCK RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14143
Mailing Address - Country:US
Mailing Address - Phone:716-801-1427
Mailing Address - Fax:
Practice Address - Street 1:9629 CLIPNOCK RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:NY
Practice Address - Zip Code:14143-9547
Practice Address - Country:US
Practice Address - Phone:716-801-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist