Provider Demographics
NPI:1174950513
Name:BELFORT, CHRISTIE ANN (ATC)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:ANN
Last Name:BELFORT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7760
Mailing Address - Country:US
Mailing Address - Phone:734-339-5385
Mailing Address - Fax:
Practice Address - Street 1:100 ELM ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5128
Practice Address - Country:US
Practice Address - Phone:617-394-2490
Practice Address - Fax:617-389-5841
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer