Provider Demographics
NPI:1316062912
Name:DEESE, CHRISTY (PT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:DEESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 SEACLIFF DR N
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7137
Mailing Address - Country:US
Mailing Address - Phone:251-209-5010
Mailing Address - Fax:251-342-2060
Practice Address - Street 1:5920 GRELOT RD STE 2
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3606
Practice Address - Country:US
Practice Address - Phone:251-342-9008
Practice Address - Fax:251-342-2060
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23028225100000X
TX1090553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20-2556008OtherEIN FOR DEESE & MAXEY PC
ALQ16196Medicare UPIN
AL051554791Medicare ID - Type UnspecifiedCHRISTY DEESE, PT
AL051556157Medicare ID - Type UnspecifiedDEESE & MAXEY PC