Provider Demographics
NPI:1194826263
Name:BRANCO, CHRISTINE T (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:T
Last Name:BRANCO
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 1:5919 OLEANDER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4780
Mailing Address - Country:US
Mailing Address - Phone:910-799-9700
Mailing Address - Fax:910-799-9780
Practice Address - Street 1:5919 OLEANDER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4780
Practice Address - Country:US
Practice Address - Phone:910-799-9700
Practice Address - Fax:910-799-9780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078TXOtherBCBS
NC078TXOtherBCBS