Provider Demographics
NPI:1225859622
Name:KEITH, CHRISTINA (CMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6948
Mailing Address - Country:US
Mailing Address - Phone:408-823-5876
Mailing Address - Fax:
Practice Address - Street 1:1021 BLOSSOM HILL RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1188
Practice Address - Country:US
Practice Address - Phone:408-459-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
199888OtherAMERICAN MASSAGE THERAPY ASSOCIATION (AMTA)
CA5855OtherCALIFORNIA MASSAGE THERAPY COUNCIL (CAMTC)
772601OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK (NCBTMB)