Provider Demographics
NPI:1962856799
Name:RAFFENAUD, CHRISTINA THERESA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:THERESA
Last Name:RAFFENAUD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E 16TH ST
Mailing Address - Street 2:#210 E
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3794
Mailing Address - Country:US
Mailing Address - Phone:616-610-3172
Mailing Address - Fax:
Practice Address - Street 1:603 E 16TH ST
Practice Address - Street 2:#210 E
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3794
Practice Address - Country:US
Practice Address - Phone:616-610-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002499225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist