Provider Demographics
NPI:1306161864
Name:PLANCK, CHRISTINA JO (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:JO
Last Name:PLANCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PRINCESS DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1142
Mailing Address - Country:US
Mailing Address - Phone:734-981-4821
Mailing Address - Fax:
Practice Address - Street 1:222 PRINCESS DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1142
Practice Address - Country:US
Practice Address - Phone:734-981-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001588225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant