Provider Demographics
NPI:1144431057
Name:ELYZE-VITAL, CHRISTINA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:ELYZE-VITAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 SARAH WAY
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37860-8971
Mailing Address - Country:US
Mailing Address - Phone:423-318-8021
Mailing Address - Fax:423-318-8021
Practice Address - Street 1:4850 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3098
Practice Address - Country:US
Practice Address - Phone:423-787-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist