Provider Demographics
NPI:1871738518
Name:CHRISTENSEN, MARY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:CHRISTENSEN
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 1:305 LOVEJOY RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9188
Mailing Address - Country:US
Mailing Address - Phone:585-526-6898
Mailing Address - Fax:
Practice Address - Street 1:270 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1832
Practice Address - Country:US
Practice Address - Phone:315-536-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006056-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics