Provider Demographics
NPI:1578312468
Name:CHRISTOFFERSON, ANNIE E (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:E
Last Name:CHRISTOFFERSON
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 N BROOKLINE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4810
Mailing Address - Country:US
Mailing Address - Phone:661-904-4676
Mailing Address - Fax:
Practice Address - Street 1:173 RICHARDS BUILDING
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-2000
Practice Address - Country:US
Practice Address - Phone:801-422-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13982690-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer