Provider Demographics
NPI:1982775169
Name:LACHANCE, CHRISTINE MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:LACHANCE
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 1:380 HUKU LII PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7043
Mailing Address - Country:US
Mailing Address - Phone:808-879-0077
Mailing Address - Fax:
Practice Address - Street 1:380 HUKU LII PL
Practice Address - Street 2:SUITE 105
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7043
Practice Address - Country:US
Practice Address - Phone:808-879-0077
Practice Address - Fax:808-879-0177
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11261225100000X
NY024577225100000X
HI2631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58908801Medicaid
HI58908801Medicaid
HI102205Medicare PIN