Provider Demographics
NPI:1720605744
Name:CHRISTENSEN, COLLIN D (PT)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 PARKLAWN DR STE Q
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2938
Mailing Address - Country:US
Mailing Address - Phone:262-228-2456
Mailing Address - Fax:
Practice Address - Street 1:2325 PARKLAWN DR STE Q
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2938
Practice Address - Country:US
Practice Address - Phone:262-228-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15107-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist