Provider Demographics
NPI:1154398287
Name:MADER, CHRISTIE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARIE
Last Name:MADER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-9758
Mailing Address - Country:US
Mailing Address - Phone:320-492-3547
Mailing Address - Fax:
Practice Address - Street 1:3285 RIVIERA RD
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-9758
Practice Address - Country:US
Practice Address - Phone:320-492-3547
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant