Provider Demographics
NPI:1285076109
Name:PROCTOR, CHRISTINA CAROL (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CAROL
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:CAROL
Other - Last Name:STIFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:17326 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4133
Mailing Address - Country:US
Mailing Address - Phone:281-332-3000
Mailing Address - Fax:281-332-9171
Practice Address - Street 1:17326 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4133
Practice Address - Country:US
Practice Address - Phone:281-332-3000
Practice Address - Fax:281-332-9171
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1229043208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1229043OtherPT LICENSE