Provider Demographics
NPI:1932242625
Name:MCCORMACK, CRISTI D (ATC)
Entity Type:Individual
Prefix:
First Name:CRISTI
Middle Name:D
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5050
Mailing Address - Country:US
Mailing Address - Phone:714-321-6341
Mailing Address - Fax:714-538-1547
Practice Address - Street 1:832 WILLOW DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5050
Practice Address - Country:US
Practice Address - Phone:714-321-6341
Practice Address - Fax:714-538-1547
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer