Provider Demographics
NPI:1215942149
Name:AWDYCKI, CHRISTINE F (MSPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:AWDYCKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 MAIN ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-4254
Mailing Address - Country:US
Mailing Address - Phone:978-449-9772
Mailing Address - Fax:978-449-9778
Practice Address - Street 1:493 MAIN ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-4254
Practice Address - Country:US
Practice Address - Phone:978-449-9772
Practice Address - Fax:978-449-9778
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68966Medicare ID - Type Unspecified