Provider Demographics
NPI:1962772046
Name:AMAYA, CHRISTINA ROSE (PT ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ROSE
Last Name:AMAYA
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ROSE
Other - Last Name:AMAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT ASSISTANT
Mailing Address - Street 1:304645 SPICA CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-440-9412
Mailing Address - Fax:
Practice Address - Street 1:30465 SPICA CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3250
Practice Address - Country:US
Practice Address - Phone:951-440-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist