Provider Demographics
NPI:1396041661
Name:NIX, CHRISTINA L (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:NIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:BRASHARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2501
Mailing Address - Country:US
Mailing Address - Phone:405-224-3100
Mailing Address - Fax:405-224-3102
Practice Address - Street 1:304 S 29TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2501
Practice Address - Country:US
Practice Address - Phone:405-224-3100
Practice Address - Fax:405-224-3102
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4348OtherPT LICENSE NUMBER