Provider Demographics
NPI:1760207112
Name:SERGOTT, CHRISTINA ANN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:SERGOTT
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 1:5015 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2642
Mailing Address - Country:US
Mailing Address - Phone:605-271-8160
Mailing Address - Fax:605-271-8162
Practice Address - Street 1:5015 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2642
Practice Address - Country:US
Practice Address - Phone:605-271-8160
Practice Address - Fax:605-271-8162
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT12063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist