Provider Demographics
NPI:1194117143
Name:ATWOOD, CHRISTINA (LMT, CPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 W NORTHWEST HWY
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3460
Mailing Address - Country:US
Mailing Address - Phone:469-878-7608
Mailing Address - Fax:
Practice Address - Street 1:6211 W NORTHWEST HWY
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3460
Practice Address - Country:US
Practice Address - Phone:469-878-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32015246567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist