Provider Demographics
NPI:1932954559
Name:HARTIN, CHRISTINA (RT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HARTIN
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2811
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2811
Mailing Address - Country:US
Mailing Address - Phone:208-818-2350
Mailing Address - Fax:208-818-2350
Practice Address - Street 1:25796 N RAMSEY RD
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-8890
Practice Address - Country:US
Practice Address - Phone:208-818-2350
Practice Address - Fax:208-277-2555
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARE61555014225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist