Basic Information
| Provider Information | |||||||||
| NPI: | 1003141748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTOPH | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2638 TULIP LN STE B | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543132801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206094551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2638 TULIP LN STE B | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543132801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206094551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 10/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 3322-46 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.