Basic Information
| Provider Information | |||||||||
| NPI: | 1912245770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAKE | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 LARKINBURG RD | ||||||||
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| City: | TROY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660874064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857411563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712242040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1105 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.