Provider Demographics
NPI:1497330872
Name:FIELDS, CHRISTA PETERSEN (LPTA)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:PETERSEN
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 QUARTERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:VA
Mailing Address - Zip Code:24122-2535
Mailing Address - Country:US
Mailing Address - Phone:434-851-7141
Mailing Address - Fax:
Practice Address - Street 1:1704 QUARTERWOOD RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:VA
Practice Address - Zip Code:24122-2535
Practice Address - Country:US
Practice Address - Phone:434-851-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant