Provider Demographics
NPI:1669727962
Name:CHRISTIANSEN, MEREDITH BRUNETTE (DPT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:BRUNETTE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:MARIE
Other - Last Name:BRUNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1650 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6916
Mailing Address - Country:US
Mailing Address - Phone:972-698-1140
Mailing Address - Fax:
Practice Address - Street 1:1650 REPUBLIC PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6916
Practice Address - Country:US
Practice Address - Phone:972-698-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1220500225100000X, 2251X0800X
OR06844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist