Provider Demographics
NPI:1629456249
Name:UTLEY, CHRISTIN
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:UTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 E BONANZA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2198
Mailing Address - Country:US
Mailing Address - Phone:702-800-2495
Mailing Address - Fax:702-441-1524
Practice Address - Street 1:3551 E BONANZA RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2198
Practice Address - Country:US
Practice Address - Phone:702-800-2495
Practice Address - Fax:702-441-1524
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner