Provider Demographics
NPI:1023306883
Name:LIEB, CHRISTINA R (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:LIEB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SGRICCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 LINCOLN AVE SUITE 209
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:1145 BOWER HILL ROAD #101
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15243
Practice Address - Country:US
Practice Address - Phone:412-276-6637
Practice Address - Fax:412-276-2206
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021384225100000X
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026185830001Medicaid
PA152066Medicare UPIN