MEDICARE: MR. CHRIS SPALDING ATC, PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	AT 3785	CA
2	2255A2300X	Athletic Trainer	840263	CA

General Provider Information

NPI Number	:	1801858980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS SPALDING ATC, PTA

Provider Business Mailing Address
First Line	:	PO BOX 1331
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-8331
Country	:	US
Telephone Number	:	619-805-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 VICTOR WHARF ACCESS RD
Second Line	:	NSWG-3 SPORTS MEDICINE
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3400
Country	:	US
Telephone Number	:	619-805-5435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/04/2014

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