Provider Demographics
NPI:1962068692
Name:SMITH, CHRISTINA M (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:DIETERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3906 ROCK SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1244
Mailing Address - Country:US
Mailing Address - Phone:210-865-9700
Mailing Address - Fax:
Practice Address - Street 1:9810 FM 1960 BYPASS RD W STE 190
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3522
Practice Address - Country:US
Practice Address - Phone:281-446-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist