Provider Demographics
NPI:1063714251
Name:CREECH, MARY CHRISTENSON (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTENSON
Last Name:CREECH
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2408
Mailing Address - Country:US
Mailing Address - Phone:804-526-0608
Mailing Address - Fax:
Practice Address - Street 1:113 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2408
Practice Address - Country:US
Practice Address - Phone:804-526-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601490225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant