Provider Demographics
NPI:1386948438
Name:MOODY, CHRISTINE TONER (LMT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:TONER
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7231
Mailing Address - Country:US
Mailing Address - Phone:321-759-7759
Mailing Address - Fax:
Practice Address - Street 1:910 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1518
Practice Address - Country:US
Practice Address - Phone:719-219-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist