Healthcare Provider Details

I. General information

NPI: 1326646977
Provider Name (Legal Business Name): CHRISTOPHER DAVID PATRICK PT., DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 BRIDGEPORT AVE
SHELTON CT
06484-5303
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 475-882-1440
  • Fax: 475-209-5002
Mailing address:
  • Phone: 610-580-5200
  • Fax: 610-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12853
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: