Provider Demographics
NPI:1902875388
Name:ACCETTELLA, CHRISTINE CATHARINE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:CATHARINE
Last Name:ACCETTELLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FORDHAM DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5368
Mailing Address - Country:US
Mailing Address - Phone:757-361-3954
Mailing Address - Fax:757-361-3957
Practice Address - Street 1:1400 FORDHAM DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5368
Practice Address - Country:US
Practice Address - Phone:757-361-3954
Practice Address - Fax:757-361-3957
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006706225100000X
NY0126000619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496680Medicare ID - Type Unspecified