Provider Demographics
NPI:1053718304
Name:WARREN, CHRISTY NICOLE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:NICOLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:NICOLE
Other - Last Name:MEDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 HOSPITAL PL
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7559
Mailing Address - Country:US
Mailing Address - Phone:907-714-4534
Mailing Address - Fax:907-262-4783
Practice Address - Street 1:44604 STERLING HWY
Practice Address - Street 2:UNIT A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7962
Practice Address - Country:US
Practice Address - Phone:907-420-0640
Practice Address - Fax:907-420-0630
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15299225100000X
OHPTA.08245225200000X
AKPHYP2867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant