Provider Demographics
NPI:1316967680
Name:DECOURCY, CHRISTINA LYNNE (LATC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNNE
Last Name:DECOURCY
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MOULTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1223
Mailing Address - Country:US
Mailing Address - Phone:781-929-8048
Mailing Address - Fax:
Practice Address - Street 1:787 BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1004
Practice Address - Country:US
Practice Address - Phone:978-626-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MA21632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer