Basic Information
Provider Information
NPI: 1003141748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTOPH
FirstName: TONYA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
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OtherLastName:  
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Mailing Information
Address1: 2638 TULIP LN STE B
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543132801
CountryCode: US
TelephoneNumber: 9206094551
FaxNumber:  
Practice Location
Address1: 2638 TULIP LN STE B
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543132801
CountryCode: US
TelephoneNumber: 9206094551
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/14/2009
LastUpdateDate: 10/14/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X3322-46WIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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