Basic Information
| Provider Information | |||||||||
| NPI: | 1134361413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMA | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 11700 MUKILTEO SPEEDWAY | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | MUKILTEO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982755432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253499692 | ||||||||
| FaxNumber: | 4253499694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 06/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60069091 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0247440 | 01 | WA | DEPT OF L&I | OTHER | 8538365 | 01 | WA | DSHS | OTHER | 3045TO | 01 | WA | REGENCE | OTHER | 4293TO | 01 | WA | REGENCE | OTHER | 4369TO | 01 | WA | REGENCE | OTHER | 4936TO | 01 | WA | REGENCE | OTHER | 6493TO | 01 | WA | REGENCE | OTHER | 8950945 | 01 | WA | CRIME VICTIMS | OTHER | 5467TO | 01 | WA | REGENCE | OTHER |