Healthcare Provider Details

I. General information

NPI: 1881981132
Provider Name (Legal Business Name): CHRISTOPHER ALAN BARBOUR RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 COLORADO AVE
CARBONDALE CO
81623-1715
US

IV. Provider business mailing address

641 COLORADO AVE
CARBONDALE CO
81623-1715
US

V. Phone/Fax

Practice location:
  • Phone: 970-404-0758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6714
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24792
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number05006810A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number18005
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: