Basic Information
Provider Information
NPI: 1699731315
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CABELKA
FirstName: CHRISTINE
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2170
Address2:  
City: SUMNER
State: WA
PostalCode: 983900480
CountryCode: US
TelephoneNumber: 2538402313
FaxNumber: 2538406340
Practice Location
Address1: 2701 W SUPERIOR ST STE 112
Address2:  
City: DULUTH
State: MN
PostalCode: 558061885
CountryCode: US
TelephoneNumber: 2187271180
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/21/2006
LastUpdateDate: 05/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00010080WAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X9543MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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