Provider Demographics
NPI:1063743086
Name:HINZE, CHRISTOPHER JACOB (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JACOB
Last Name:HINZE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PAVILIONS CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3198
Mailing Address - Country:US
Mailing Address - Phone:231-932-3169
Mailing Address - Fax:231-932-3024
Practice Address - Street 1:1000 PAVILIONS CIR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3198
Practice Address - Country:US
Practice Address - Phone:231-932-3169
Practice Address - Fax:231-932-3024
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B81315OtherBLUE CROSS BLUE SHIELD MI
MI4797005Medicaid