Provider Demographics
NPI:1891837126
Name:FALL, CHRISTINE M (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:FALL
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 1:121 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1629
Mailing Address - Country:US
Mailing Address - Phone:781-593-9090
Mailing Address - Fax:781-593-9093
Practice Address - Street 1:121 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1629
Practice Address - Country:US
Practice Address - Phone:781-593-9090
Practice Address - Fax:781-593-9093
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0038053OtherNEIGHBORHOOD HEALTH PLAN
MAY68555OtherBCBS
MA0340031Medicaid
MA414513OtherTUFTS
MAY69163OtherCOMMONWEALTH CARE ALLIAN.
MA414513OtherTUFTS