Provider Demographics
NPI:1538240692
Name:CHRISTIAN, KEISHA ELEANORA (PT)
Entity type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:ELEANORA
Last Name:CHRISTIAN
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 1:106 FOUNTAIN BROOK CIRCLE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-463-0110
Mailing Address - Fax:919-463-0610
Practice Address - Street 1:106 FOUNTAIN BROOK CIR
Practice Address - Street 2:SUITE B4
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4478
Practice Address - Country:US
Practice Address - Phone:919-463-0110
Practice Address - Fax:919-463-0610
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist