| NPI | 1073512257 |
|---|---|
| Former Name | CHRISTIE MARIE STACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT2999) |
| 225100000X Physical Therapist (Licence: VA 2305202173) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |