Provider Demographics
NPI:1285092643
Name:BROWN, CHRISTINA
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4937 SPRING RD
Mailing Address - Street 2:P. O. BOX 168
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-3526
Mailing Address - Country:US
Mailing Address - Phone:315-361-5654
Mailing Address - Fax:
Practice Address - Street 1:4937 SPRING RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3526
Practice Address - Country:US
Practice Address - Phone:315-361-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026370-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist