Provider Demographics
NPI:1093801706
Name:CHRISTY, JUDITH (CS PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:CS PRACTITIONER
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:CHRISTYMAQUEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:27451 435TH AVE
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1814
Mailing Address - Country:US
Mailing Address - Phone:218-820-0678
Mailing Address - Fax:
Practice Address - Street 1:27451 435TH AVE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1814
Practice Address - Country:US
Practice Address - Phone:218-820-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X, 374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN374T00000XOtherC S PRACTITIONER