Provider Demographics
NPI:1730105339
Name:MACHIELSON, CHRISTINA P (DPT,OCS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:P
Last Name:MACHIELSON
Suffix:
Gender:F
Credentials:DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-1361
Mailing Address - Country:US
Mailing Address - Phone:260-478-5230
Mailing Address - Fax:260-478-5235
Practice Address - Street 1:3534 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-1361
Practice Address - Country:US
Practice Address - Phone:260-478-5230
Practice Address - Fax:260-478-5235
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7368174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650000906Medicare ID - Type Unspecified