Provider Demographics
NPI:1154539690
Name:DEARBORN, CHRISTINE MARIE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DEARBORN
Suffix:
Gender:F
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:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:CENTER OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03814-0802
Mailing Address - Country:US
Mailing Address - Phone:603-536-1549
Mailing Address - Fax:603-447-1114
Practice Address - Street 1:182 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6140
Practice Address - Country:US
Practice Address - Phone:603-447-6356
Practice Address - Fax:603-447-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30390418Medicaid